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Prostate Cancer
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Posted 5/26/2023 8:40 AM (GMT 0)
Here I am again, unfortunately.
As can be seen in my signature, my PSA has started to rise at an accelerated pace, even though still low at 0.16ng/ml. It seems that some lurkers managed to stay behind after my RALP.
MRI and CT scans done about 6 months ago revealed nothing.
I have scheduled an appointment with my RO, I know from previous consultations that she wants me to have 50 treatments of SRT to the pelvic floor. She will probably also want to put me onto a course of ADT.
Is this the best treatment for my current condition. I am otherwise healthy, very fit and lead a very active lifestyle. I am very anxious that the above treatments will have a severe impact on my quality of life.
My concerns with the SRT is reminds me carpet bombing an area without knowing where the enemy actually is.
My concern with the ADT is that it would make it easier for the tumor to "hide".
Posted 5/26/2023 10:10 AM (GMT 0)
Sea Diver

Sorry about that news. Yes some of the critters were left behind and it seems you already are in touch with a RO.

Its a frustrating thing for sure not knowing exactly where its hiding. The care they are recommending is based on the observations from many men that most likely its near
- where your prostate was or
- in a nearby lymph node.

No guarantee though.

The course of hormone therapy is temporary. You will notice it but you are active so stay active and the time will fly by. Make sure you lift some weights a few days a week.

The good news here is that you are still curable. Focus on that.

This is a road bump.

Good luck!
Posted 5/26/2023 11:15 AM (GMT 0)
You were pT3b N0 MX after surgery, but your signature is missing (a) your final Gleason score, (b) the number of lymph nodes removed and examined, plus, perhaps, (3) any additional adverse findings mentioned in the report. A post-op path report automatically becomes the Main Act needed in signatures; biopsy reports become backup singers after surgery.

I would have a Decipher test done on your RP tissue. *IF* that should come back low risk for mets, and you had a good number of negative nodes removed, it is likely that your seminal vesicle invasion led to (only) a local recurrence. Is there some other reason that your doc wants to add ADT? You could inquire about the statistical chances of a PSMA-PET scan revealing existing mets given your current PSA (I believe this is only 50% for a PSA < 0.5). In addition to helping with the necessity of ADT, it might help with the question of fossa-only vs. whole-pelvis salvage RT.

Djin
Posted 5/26/2023 12:23 PM (GMT 0)

Very Deep Sea Diver said...
Here I am again, unfortunately.
As can be seen in my signature, my PSA has started to rise at an accelerated pace, even though still low at 0.16ng/ml.

Not necessarily considered low as far as Salvage Radiation is concerned. You clearly have a recurrence based on your steady PSA increase. The sooner you get going on SR the better your likely outcome. ADT won't help the cancer hide, but it can weaken the cancer, making the radiation possibly more effective.

Good Luck!
Posted 5/26/2023 2:43 PM (GMT 0)
I think that I was 60-61yo when I was at that point on this journey. And I was still running, mtn. Biking and canoeing at that time. And I recall that I slowed down a little but after treatment it did not take me long to reclaim my fitness. So I would not worry about that aspect of treatment. Wishing you well and keep us posted.
Michael
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