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Rapidly rising PSA for re-recurrent prostate cancer initially diagnosed G6

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Posted 10/6/2018 11:41 PM (GMT 0)
In 2011, I had brachytherapy for prostate cancer diagnosed as G6. In 2016, a second biopsy found extraprostatic recurrence. I had cyberknife in January 2017 for it together with ADT from October 2016 to April 2017. PSA went down to undetectable (< 0.1) very rapidly and stayed there until January 2018. Then it started rapidly: April 6: 0.2, July 13: 0.9, August 28: 1.3 and October 4: 1.8. The PSA doubling time using these values is 2.14 month.

In August, a bone scan and a CT scan were negative. I have an Axumin PET/CT scan scheduled for coming Friday and I will see an MO the following Monday.

My URO is ready to start intermittent ADT treatment. What troubles me is the very short PSADT. How long can I wait before starting ADT?

I know I will get some replies pointing out that perhaps some higher grade cancer was missed by the initial TRUS biopsy in 2011 because G6 cancer cannot spread. Please don't bother. I have heard it too many times and I am very much aware of what G6 cancer can or cannot do.

What I would welcome is suggestions on future course of treatment. I know the choice is very limited. I am hoping that the Axumin PET/CT scan will yield some answer for my re-recurrent cancer.
Posted 10/7/2018 12:55 AM (GMT 0)
basically, ADT is the first step - you ride that train till it ends and the you start other stuff. There's a lot left after that. The question really is how long will ADT be effective. Could be anything from a couple of years to a decade. Intermittent ADT is good because you get some breaks.

How long to wait to start? Tricky question. Any time really. You wait for the PSA to go a bit higher so the scan has a better chance at finding where the PC is, but it's up to you - but I'd think you'd want to be starting in a couple of months at the outside.

Andrew
Posted 10/7/2018 1:52 AM (GMT 0)
Have you looked into cryotherapy. It’s one of the salvage options available after RT has failed. I have seen one member on this forum whose signature shows some success of cryo after failed RT.

You have to act on it pretty fast and hope it’s still localized.
Posted 10/7/2018 1:59 AM (GMT 0)
I understand and applaud your caveat reference...gl6 and all the miracles associated with that diagnosis...folks still don't get it and swallow the proverbial log and choke on the splinter...everone...everyone has a unique and direct straight line to the mysteries...that...that reciprocal straight line creates back to them from birth...most folks fear and/or serve that line...rather than reaping the blessings thereof...You are a " lucky " guy who seems to have cracked the code...good on ya...just remember Satchel Paige...he'll keep ya honest...and away from the Borg

recurrent...re cure...do the math folks... Brunhilder never gets a chance to sing...lessen there is Soap involved and all the drama that operates therein...riddle me that!! its All there after Borg...all is... well...operative...PS...sensing...is much more enlightening...than understanding...do we really want the end point prior to it...
Posted 10/7/2018 3:01 AM (GMT 0)
I'd do nothin'. I'd wait until the MO meeting with the scans.
Posted 10/8/2018 3:01 PM (GMT 0)
Did your RO rule out HDR or SBRT? Even stranded seeds can be strategically placed to include a certain margin outside the capsule. I am a not a doctor just speaking out loud trying to avoid ADT and no more.
Posted 10/8/2018 4:19 PM (GMT 0)
My medical history is different from yours in that I had surgery and SRT - not brachy. But like you I had a suddenly rapid increase in PSA levels - from 0.2 to 6.6 in about 18 months and a doubling time that dropped quickly from more than 6 months to 2 - 3 months.

My MO started me on ADT (Firmagon) this past May and my T and PSA both dropped to nearly undetectable in two months. He says the speed and extent of my response suggests to him that ADT should be effective for a long time and once I start my first ADT vacation next May he may allow my PSA to rise higher than he might otherwise before starting the next round - though ... who knows?
Jim
Posted 10/8/2018 6:19 PM (GMT 0)
Well, I am a G9 and I do have recurrent. Currently I'm on a vacation from HT. My Onco wants to wait for my PSA to go up from 0.08 to 1.5 to 2.0 before restarting treatment. His reasoning is to have an Axumin scan performed. It will pick up mets better the higher the PSA.

FYI my PSADT is 6-8 weeks, so it should take less than a year to reach that range.
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