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Posted 6/8/2024 10:58 PM (GMT 0)
Seems I am joining the team of those with decisions on next course of action. Signature tells the tale since Aug 2017. Here is the current situation in PSA (all LabCorp) monitoring:

07/27/22 <0.006
01/12/23 <0.1 (Lab ran standard), so on
01/18/23 0.009
02/20/23 0.007
09/18/23 0.010
03/20/24 0.040
06/07/24 0.047

Trying to contact doctor I have been seeing; however, near impossible to get correspondence to him so he will most likely be replaced in the very near future.

My thoughts are to meet with a RO to discuss future "what's next" along with a MO as well. This is rather new ground for me as I underwent RT when at the 0.030 level.

I reside in the San Antonio, Texas, area so if anyone can recommend good RO & MO it would be appreciated. I would like to avoid MD Anderson in Houston, as they work closely with UTSA and the Mays Cancer Institute here in San Antonio, I believe there is someone here for me locally.

Appreciate your time gentlemen. May God bless and protect us all. Very respectfully.
Posted 6/9/2024 3:02 AM (GMT 0)
NorCal - You are right, seems to be a number of men lately which creeping PSA. You probably just need to read recent posts and you will have your answer?

Your PSA is still very low so you are in the zone with nothing to do but watch PSA which must be frustrating. Lining up your doctors is about all you can do and work on a game plan if and when your PSA reaches 0.20, the next decision point. You hope you get lucky with a PSMA scan and find something for the RO to “fix” and knock your PSA back down.

Sorry, can’t help with Texas doctors, someone may know the local market here.
Posted 6/9/2024 10:52 AM (GMT 0)
NorCal, I agree with Mumbo. Watch, wait and research docs that truly specialize in recurrent PCa. Keep testing at least quarterly with the same service and start plotting all the tests to attempt to determine PSA doubling time (PSADT).

It looks like you were on ADT for a very short time and it has been several years since it was stopped. Correct? Did your SRT include radiation to the pelvic lymph nodes? With your history it appears unlikely that any cancer is in the prostate bed and is very likely systemic. More likely, in my non-professional opinion, some PCa was already out of the area, possibly in the bones somewhere. It is well established that PCa, like breast cancer, can go dormant in bone for several years before awakening and becoming detectable.

As Mumbo says, you are a distance before any scans can detect any cancer location. Thus you have some options. One would be to wait and allow the cancer to grow until it can be located and potentially treated. The problem is you are allowing the cancer to grow and strengthen it potentially allowing it to spread to numerous areas and making it more difficult to treat.

On the other hand, you could determine with the apparent PSA progression that there is cancer and start treating with ADT. If it knocks your PSA down it would clearly indicate there is some cancer somewhere. As long as things are going well you could pursue an intermittent strategy with several months on ADT, then take a vacation from treatment and see what develops. The issue with this option is that you may never allow the cancer to grow enough to be seen on a scan for radiation treatment.

There are doctors that will opt of the former and other docs will opt for the latter. I suggest you get assessments that consider both options. Best Wishes.
Posted 6/9/2024 8:29 PM (GMT 0)
Another way to look at your test results:

07/27/22 <0.006
01/12/23 <0.1
01/18/23 <0.1
02/20/23 <0.1
09/18/23 <0.1
03/20/24 <0.1
06/07/24 <0.1

If you put it that way your question seems misplaced. But since you run the sensitive test I'd just keep at it and eat ice cream regularly.
Posted 6/9/2024 8:34 PM (GMT 0)
I suggest you discuss the outcome of the PEACE-1 trial with your medical oncologist.

The outcome of the ARASENS trial may be relevant too (at some point).

https://www.nejm.org/doi/full/10.1056/nejmoa2119115

Best wishes!
Posted 6/9/2024 10:11 PM (GMT 0)

GoBucks said...
Another way to look at your test results:

07/27/22 <0.006
01/12/23 <0.1
01/18/23 <0.1
02/20/23 <0.1
09/18/23 <0.1
03/20/24 <0.1
06/07/24 <0.1


If you put it that way your question seems misplaced. But since you run the sensitive test I'd just keep at it and eat ice cream regularly.

Exactly GoBucks.

This is why I still think sensitive PSA tests don't really make sense for anyone other than post-RP patients. In every other situation the sensitive tests seem to be good for one thing: generating unnecessary anxiety. The 0.1 PSA tests work just fine for all other situations, as far as I know. So why do I use 0.01 PSA tests? That's a very good question. When my PSA eventually returns it will probably float around between 0.01 and 0.10 for a long time, just because cancer likes to **** with you like that. Maybe I will talk to my MO about switching tests, but it seems like I always say that.

In any case I will continue to eat ice cream every day. Mint chocolate chip is the best, but I keep several flavors on hand at all times.
Posted 6/10/2024 12:00 AM (GMT 0)
While I don’t usually eat ice cream, I do live for summer and the Chic Filet Peach Milk Shake. I plan to have three per week and will certainly gain a few pounds between now and Labor Day. Oh well. It is what it is.

As for PSA tests I like the single digit one I have been using for more than a decade. Hopefully by Monday I will receive another < sign.
Posted 6/10/2024 2:08 AM (GMT 0)

GoBucks said...
Another way to look at your test results:

07/27/22 <0.006
01/12/23 <0.1
01/18/23 <0.1
02/20/23 <0.1
09/18/23 <0.1
03/20/24 <0.1
06/07/24 <0.1

If you put it that way your question seems misplaced. But since you run the sensitive test I'd just keep at it and eat ice cream regularly.

Interesting comment. I was testing in 6 month cycles and prior to this situation had planned on moving to annual testing utilizing the standard LC testing. This because of the increased stress possible from the ultra sensitive. Now I have increased monitoring concerns as I will fall back to 3 month testing. Mays Cancer Center is a center of excellence so believe I will attempt to move into their system. It is what it is.

Gentlemen , thank you for the excellent comments.
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