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11 month post RP PSA

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Posted 8/23/2023 2:29 PM (GMT 0)
Husband had his 11 month PSA test yesterday. The result is 0.05. So far, this is what we have,
11/2022 - <0.04
02/2023 - 0.05
05/2023 - <0.04
08/2023 - 0.05
They checked his Testosterone and it was 409, the test range was 250-827.
So, I guess we are good and any thoughts appreciated.
Truthfully, I miss the < sign
Posted 8/24/2023 11:30 AM (GMT 0)
The less than sign is indeed the most appreciated character on this forum.

Since one of his lymph nodes showed signs of cancer and he is waffling between detectable/non detectable i would start looking around for a radiation oncologist. Most guys in that situation will eventually have hormone therapy for a period of time along with radiation to the area where the prostate was and nearby pelvic lymph nodes.

The hormone therapy will slow any growth and then the radiation will eradicate it.

He is still curable/can have a long durable remission but realize that they are shooting blind. They dont know exactly where the remnants are. They are taking their best guess.

The low decipher score is very encouraging.

So keep up with the testing but plan on further action. Perhaps test monthly to make sure there are no big jumps

Did he heal ok from surgery?
Posted 8/24/2023 12:06 PM (GMT 0)
After I had two successive test results without the <, my uro suggested I initiate radiation therapy. There is a debate about how high psa should rise before starting RT, but there is a lot of support for the idea of starting it earlier rather than later -- basically a soon as you are sure it is rising. In my case the radiation oncologist did not recommend hormone therapy.
Posted 8/24/2023 12:36 PM (GMT 0)
Hard to keep up with science but like fiddlecanoe, I also did not have hormone therapy with adjuvant radiation. I questioned my RO about it and was told that there was no advantage with PSA < 0.10 and prompt radiation treatment (ART). I also researched studies that said the same thing in 2019 so agreed with recommendation.

My thoughts are a little different than Stephen’s on PSA testing, it always best to get PSA testing on a uniform schedule with enough time between tests that increases can be spotted with some confidence and not just small variations in results. However, I agree with getting a consultation with a radiation oncologist so he can get an opinion from the doctor that specializes in such treatment. Different doctors, different opinions.
Posted 8/24/2023 2:04 PM (GMT 0)

Mumbo said...
Hard to keep up with science but like fiddlecanoe, I also did not have hormone therapy with adjuvant radiation. I questioned my RO about it and was told that there was no advantage with PSA < 0.10 and prompt radiation treatment (ART). I also researched studies that said the same thing in 2019 so agreed with recommendation.

When I had SRT in 2018, my Dr had told me that he would be comfortable with me not doing ADT as long as I commenced treatment before PSA reached .1 (I started at .08 and chose ADT anyway).
He as well as an RO at Cleveland Clinic in Florida cited studies showing that the earlier the better, once a trend has been established
Posted 8/24/2023 3:24 PM (GMT 0)
Solid advice, IMHO.
Posted 8/24/2023 4:18 PM (GMT 0)
Thank you for all the advice.
We are close to Roswell Park Cancer Center and had our second opinion there and liked the Radiation Dept and Doctor Kuettel. At the time he did not recommend radiation and thought surgery was his best option. So surgery it was.
We have a 3 month schedule with the Urologist and see him on Wednesday. I will bring up the recommendations and ask about seeing Dr. Kuettel again for a future plan. I would be very interested, but the husband will do what the Urologist tells him.
He has recovered from the surgery with no incontinence, it will be a year next month.
Posted 8/24/2023 4:52 PM (GMT 0)

Wife#1 said...
He has recovered from the surgery with no incontinence, it will be a year next month.

This is good news! The radiation then would not interfere with that progress.

Good luck with the appointment.
Posted 8/25/2023 5:02 PM (GMT 0)
I found radiation after 18m very tolerable. (I had persistent PSA of .18 and a very long doubling time almost the same as pre-op: I was 0.2 when they radiated. 52.5Gy/20.) Bed only, no nodes. Hormones are "under review" in the profession in early salvage. Personally I passed. I had a horrid, many red blocks, 97% yada yada Decipher test but my PSA is falling nicely so it looks like a "hit" for now. Nodes are harder to treat, DO need hormones (because of lower dose) and can be left to later (clearly not an option for you guys). Plus the new imaging. After the shock of the persistent PSA (Dr had cut tight because he knew I wanted the nerves) I found it easy to plan. Sounds like you're both in good hands but good luck anyway.
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