PSA UP 2 1/2 YEARS POST OP

Back again boys, Thought we had this thing beat but after 2 1/2 years psa began to rise. Salvage radiation was unsuccessful and psa continues to rise. Going to see an oncologist on Monday at Yale New Haven (Petrylak) he's supposed to be the guy to see. His last thought was that psa is still very low and scan probobly woud not show anything. Radiation oncologist has recommended to start HT which I'm not crazy about but am willing to do if it slows or shuts this son of a ***** down

sorry to hear it's still rising. Might be too soon for a scan to see anything. Good you're going to see the oncologist. The question is when to start the HT. Lots of theories on that front. You could wait until the PSA rises a bit more so a scan might be helpful, or get the shot now.

Tough call.
Andrew

Allen,
Help me understand the reasons to get detailed scans and a biopsy in Steve's case.

The OSPREY study "evaluates the safety and diagnostic performance characteristics of 18F-DCFPyL" and is the primary goal.

Ok say the scan safely worked... it found a target in the pelvis. What are the end points to having this information? I see you asked if Steve had pelvic nodes radiated. If he only had it to the bed and not the whole pelvis, are there studies showing success in going back in and radiating the pelvic area, as compared to distant target areas which would have required systemic movement thus less chance of a complete cure?
-Ken

Ken-

Treating pelvic lymph nodes is controversial, and the evidence for it does not come from RCTs. There have been 3 studies that looked at whether whole pelvic radiation is beneficial in men diagnosed with cancerous pelvic lymph nodes (N1) after they've already had a prostatectomy. Two of the studies found there was a significant survival benefit, one didn't. (see "setting C" in the link below)

/pcnrv.blogspot.com/2016/08/adt-and-radiation-for-first-line.html

It's not exactly Steve's situation, which already included some radiation to the prostate bed, but the PET scan may identify cancer in the pelvic LNs only, and if that is the case, there is no reason (other than side effects) why curative salvage radiation can't be tried.

I'm not talking about spot treatment of metastases, which there is no evidence of a survival benefit for. Understanding the limits of detection of even the best PET scan (which is currently DCFPyL), and understanding the natural history of metastatic progression, if there is any survival benefit to treating pelvic LNs, it will involve treating the entire area.