Advanced Prostate Cancer

PSA .10 at 6 weeks after surgery

New member, age 75, excellent health except PCa, psa 23.8 July 2017, DRE showed hard right side, biopsy GS 4+3 in 5/12 cores, all right side, CT scan and MRI negative for mets, psa Sep 2017 was 20.44.

laparoscopic prostatectomy 10/31/17, confirmed GS 4+3, one tumor only on right side with EPE+, left nerves spared, LN-, SV-, margins negative, extensive BPH.

At six weeks (12/14/17) psa was .10, will retest 1/26/18.

Surgeon said possibly psa is still coming down. Could also be mets or benign residual prostate tissue.

Any thoughts welcome!

9 Replies
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A very good start. Good luck with that next test!

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My only thought Is do you have an oncologist who specializes in prostate cancer on your medical team? My second only thought is what if any drugs are you currently taking, (Lupron, etc)? Sounds like you caught it early, congrats.

Of course what do I know?

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No drugs yet. After biopsy by local urologist, went to medical oncologist at Memorial Sloan Kettering. She ordered the scans and suggested either radiation or surgery or a clinical trial with 3 hormones in combination plus cyber knife. After meeting with radiation oncologist and surgeon at Sloan, I chose surgery because (1) world class surgeon said all the psa was coming from the prostate and he could get all the cancer, (2) surgery gives a definite pathology whereas radiation does not, and (3) the combination of hormones seemed risky — the clinical trial was to see how they interacted.

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It seems you have made all the right moves ,and at a Great Medical Center. I remember a study in the past with radiation to the prostate Bed in case of residual, for better cure rate. At any rate you are in a good place with lots of options should you ever need them in the future.

Dan

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I agree with Dan. Your initial treatment was a good choice at a great medical center.

Unless the PSA becomes undetectable at your next reading, I would ask about "salvage radiation" at your next appointment. If no appointment is scheduled (i.e., if only a PSA test is scheduled), and if the PSA did not go down, then I suggest asking for an appointment with a radiation oncologist. If you need salvage radiation you'll need an appointment with a rad onc first and you might as well go straight to him or her rather than waiting for an appointment with the surgeon, and then waiting again for an appointment with a rad onc.

I know all of this is worrisome and depressing, but there is quite a good chance you'll come out of this cancer free. If not, I think there is still an excellent chance that you'll be able to control the cancer with drug treatments and grow old peacefully, never experiencing a single symptom of prostate cancer.

Best of luck.

Alan

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I agree with Alan, If psa is not lower on next I would look into Radition.

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I agree with Dan and Alan. I will add that you should consider a round of ADT with radiation. My case was similar to yours except upon surgery we found that my cancer had spread into my right seminal vesicle. I did NOT have salvage radiation or hormonal therapy (ADT) until the cancer recurred three years after surgery. I think I might have been better off if my doctors had been more thorough and aggressive - I did NOT have a prostate cancer oncologist on my team - just a urologist and eventually a generalist radiation oncologist. After my second recurrence, I finally enlisted an expert PC oncologist. You would be well-served to consult with one now.

Good luck and stay healthy!

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I was a 'right sider' too. Diagnosed last year at age 66. After treatment I am doing fine so far. I have fond memories of camping / hiking trips in the Adirondacks in my youth. Now I am stuck in the desert.

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Keep on top of it...

Good Luck and Good Health.

j-o-h-n Thursday 12/21/2017 12:23 PM EST

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