Wondering best course of action? What do these number mean for my risk profile?
• Prostate Surgery April 2016,(PSA was 9.6) - last PSA – 0.48 (01/18) - PSADT 4.6 months
•Time to recurrence – 0.10 @ 9 mths; 0.2 @14 mths
•Pathological Gleason score – 4+3 (7)+T5 = act like G8
•Stage: p2Tc – PNI - (clear margins, SV, lymph nodes)
I understand men with a Gleason Score of 7 (4+3) with tertiary Grade 5 have a similar risk of PSA recurrence compared to men with Gleason Score of 8, 9–10 . Apparently the presence of PNI suggests an increased risk of metastasis.
Research suggests if PSA doubles in less than 6 months, it is likely that cancer has already metastasized to bones or organs? If the PSA level rises within the first year after surgery, it usually indicates metastatic disease.
Researchers concluded that a PSA of 0.4 ng/ml or greater reflects the threshold at which a PSA increase becomes durable and shows the strongest correlation with subsequent systemic progression.
I am in Thailand and recurrence treatment is handled by urologist unless referred to radiation oncologist. Dr plans on PSMA PET/CT scan and MRI (after next PSA test) in the next month to try and find source of rising PSA. Talked about but not certain regarding SRT. Dr said may need to look at combined therapy of ADT & Chemo if things progress? From research and use of nomograms success of salvage radiation is on 37%? Watchful waiting at the moment tracking PSA.
Thoughts on treatment steps? - all research leads to much confusion - some treat, some don't (treat cancer not PSA!) - some seek aggressive treatment and some not so before it spreads?