Slow, but continued uPSA increase

Dear Din.

At the beginning of March I will start radiotherapy sessions.

I decided to speak out because we have through a similar situation and my decisions can help you.

In June 2014, my robotic surgery took place. The pathology report was: G 8, EPE-, clear margins, LN-, SV- and my PSA was undetectable (<0.003) for 18 months.

When my PSA reached 0.05 (May/2019) I started the appointments with an oncologist. When the PSA reached 0.014 (November/2023) the oncologist requested an MRI of the prostatic fossa and to my surprise it was detected:
“Focal nodular change along the right posterolateral wall of the vesicourethral anastomosis, suspected of tissue with neovascularization and suspicion of viable neoplasia (PI-RR 5).
Discreet tissue thickening with a more nodular appearance and topography of an indeterminate right seminal vesicle (PI-RR 3).
Slightly prominent lymph node in the left external iliac chain, undetermined for secondary dissemination”

After that, he requested a PET-CT with Gallium68 PSMA to ensure that there were no metastases outside the pelvis. The diagnostic impression was as follows:
“There is no area of ​​PSMA overexpression that suggests viable neoplasia in the surgical bed, lymph node disease or bone lesions suspicious for secondary implantation.”
I didn't expect the MRI would find something with such a low PSA. See that they carried out studies on this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8887697/#:~:text=MRI%20can%20diagnose%20local%20prostate,the%20prostate%20bed%20than%20CT.

I already had the first injection of ADT and my CT scan for radiation therapy planning will be tomorrow.

I believe that the RO intends to irradiate the entire pelvis, focusing more attention on the suspicious points that were detected on the MRI. The suspicious points are right seminal vesicle and vesicourethral anastomosis.

I still have some hope of a cure, even though I know that the best chance for patients >=G8 is prostatectomy.