It's official now--BCF

hip, sorry to hear this, always tough to get that kind of confirmation.

With that said, you've been around long enough that you know this is highly treatable as a chronic disease. Keep us posted

I saw my urologist today. He was surprised that my PSA had increased so much.
He's been saying for 4 years that some incremental increases are normal and we debate this every visit. It's entirely my fault for not doing something about this earlier, especially after I had my 3rd consecutive increase in 2022. Deep down I knew it wasn't normal but I wanted to believe him. He's a great urologist and treats patients who have had primary radiation but I knew he was wrong on this. But even my RO in 2022 didn't think any action was needed since my PSA was well under the Phoenix definition of BCF. I had decided no matter what my PSA was this time I was having a PSMA.

This is the plan now:

Retest PSA after a 30 day treatment of Dicyclomine .
PSMA in the next few days.
I may have another PSA on my dime in a few days at Labcorp or Quest walk-in lab just to have a different lab and assay method. You never know. On the other hand does it really matter what the PSA is since the PSMA trumps the PSA?

hr… - you are correct, no one knows anything for sure after a biopsy, just too easy to miss a small nasty area. I think some day PSMA scans will be done before biopsies as soon as they stop arguing about MRI’s before biopsy. The technology is there to do a better job at the diagnosis stage.

As far as recurrence after primary radiotherapy there are numerous treatment options. It just depends on where the recurrent cancer is. You need the scans now, not more waiting and PSA tests, in my opinion. You already have a definitive trend and absolute value indicating PCa recurrence. Now, we need to see where it is. Is it local to the prostate? Is it in the proximate nodes? Is it somewhere in the bones? Is it visceral? Any and all of these will indicate what can be done. Options include HIFU, Cryo, HDR Brachytherapy, external beam/SBRT for Mets, ADT, etc. it just depends on where the cancer is found.

Based on your information I am presuming your initial treatment did not include the general pelvic area lymph nodes, as Proton is usually not so used, and you presented as low risk. So you could have had micro Mets in the lymph nodes that were not radiated, thus could be the recurrence site. That could be simple treatment with radiation to the nodes and a course of ADT, for example. So, until you get scans, you can’t determine what might be done.

I suggest you research using such sources as Dr Mark Schulz’s YouTube seminars as I am sure he has one or more that may provide some information and guidance in your situation. I would also be looking for an excellent medical oncologist that specializes in advanced PCa, as that is where you appear to be. In my opinion you need a new and more aggressive team leader. It also appears that you missed an annual PSA as you didn’t list a 2023 test. Am I reading that correctly? If you chart the points you will probably find the recurrent value a year ago. Time to get aggressive with the investigation and potential treatment.

I spoke with my RO who thinks I should retest PSA after course of antibiotics. If the PSA is still elevated then proceed to PSMA scan. We discussed where to have the scan and decided Duke Cancer Center would be the best option. I had my Uro's office order the scan for Feb 29 so I wouldnt have to wait any longer if the retest is still the same.

Duke has a comprehensive cancer center and use a team approach for treatment. I had mpMRI and fusion biopsy there and was impressed with the doctors and facility.

Post Edited (hrpufnstuf) : 1/27/2024 4:19:31 AM (GMT-8)

Sr. Good catch on NanoKnife. Two docs close to me using it are partners with my Urologist. One of them performed the first NanoKnife prostate cancer procedure in the US more than 10 years ago.

While it is FDA approved for some cancers, it is not on the Medicare reimbursement list. By CMS it is deemed “not medically necessary”, which is a requirement for reimbursement. This policy is reviewed each year in May. Basically, Medicare is saying that it doesn’t provide anything superior to other treatment methods currently approved for reimbursement, so no reason to add it to the reimbursement list.

Since Medicare does not have it on the approved list, many commercial insurance companies and other third party payors don’t reimburse as it is typical to follow Medicare. I understand it to be similar in cost to HIFU, so not cheap, especially if one is self-paying. Hopefully, the company and providers using it can continue to show efficacy and advantages over other treatments in order to get it on the Medicare reimbursement list.

I did not take ADT before or after.
My urologist has requested my PSMA scan to be expedited at Duke.
I have chosen Dr Andrew Armstrong as my MO at Duke. I will be meeting with him on March 5.