PSA is back 5 years after SRT :(

Just when I thought it was ok to get back in the water. I lasted three years after my daVinci RP in 2009 before my PSA creeped up to 0.26. I then had SRT in 2012 and had a nadir of .01 with a gradual increase to .027 in 2015. At that time I went off the ultrasensitive and just got <0.1 readings until today, when I got 0.2. That's almost five years after my SRT and 9 years since my RP.

I realize that's a small number, but the disease I had basically forgotten about has raised its ugly head once again. I don't even recall a lot of the details about treatments. I'm out of bullets, so I guess the only thing left is ADT at some point, although I've heard of a C11 scan for micromets.

I've made an appointment with my urologist for next week. In the meantime, I'm pretty numb right now, but should I start freaking out, or is there hope for some type of control, or at least some management? I will be 73 this year so if I get 10 years I would be happy.

Reachout,

You will see from my signature that I've been down the same road. From the results in your signature it does look to me like it is time for you to meet with an MO rather than a urologist. But the good news is that so far your increase since SRT has been very slow and the readings right now are very low - at .2 only just now crossing the threshold generally recognized as biochemical recurrence. There is some room for debate about when to begin ADT -- there was the TOAD (Timing of Androgen Deprivation) study a couple of years ago that suggests starting earlier has better long-term results. But - and this is a big But - that study result is questioned still my many MOs, including mine. My MO (at Dana-Farber) is inclined to look at both the rate of increase in addition to the absolute PSA number. As of now he tells me he will want to start me on Lupron when my PSA is between 5 and 10. If your MO, when you get one, is of a similar opinion are probably still a long way from needing to start SRT.

I've read about the C11 and similar scans. When I first read about the C11 scan at the Mayo Clinic a few years ago I thought it might be a way to postpone ADT. I no longer think so, nor do my MO or my former RO. Any mets large enough for scan to detect are just a visible part of a larger problem - namely micromets that are too small to observe which need to be treated systemically. Finding and zapping larger mets detected by a C11 or similar scan may have benefit in terms of treating pain, but without being done in conjunction with systemic treatment it pretty much amounts to playing whack-a-mole.

As for being around for another 10 years, you should have no problem as long as you avoid stepping off the curb in front of a moving bus. Rule of thumb, as I understand it, is we should have on average 8 years or so of effective ADT -- just an average, but one that should skew in favor of guys like you who have had a slow progression so far. And now there are many more new treatments available and coming on line for when ADT no longer works.

Jim