Prostate RP 6 Years psa Undetectable Recent .2 Options?

[ehiker]

Hi, 65 year old. Prostate RP 2012, pre surgery 3.7.Pathology Gleason 6. Positive Margin apex. Extra extension on top of gland. No seminal or lymph node involved. Undetectable for 6 years. Recent says .2. Doc says psa may be anomaly. Says take another test in 60 days. Says if same or even lower. says possible, retest in three months. If higher then says radiation possible course. UCSF has trial with gallium scan that may pinpoint possible location..based on my numbers doctor says if coming back probably in prostate bed. Looking for options, suggestions regarding possible BCR. Would scans detect at .2? Radiate bed best option if rising? Chance at another “cure”? with radiation? One last thought..Sloan Kettering calculator with my numbers state 97% chance non recurrence at 7 years and 91% at 10 years. I guess if psa test not a glitch someone has to be in the 3% group. Thanks for any all help/advice. dan

[Tall_Allen]

Talk to a radiation oncologist at UCSF. You want to start salvage radiation as at low a PSA as possible. You can get an Axumin PET scan covered by insurance now or you can pay for a Ga-68-PSMA scan there - neither is very good at your low PSA, but the PSMA scan is better. Most guys would get prostate bed salvage radiation regardless.

[ehiker in reply to Tall_Allen]

Thanks so much. dan

[AlanMeyer in reply to Tall_Allen]

I agree with Tall_Allen. I haven't got a citation for you but I saw a study some years ago that showed the best results for salvage radiation when PSA did not exceed 0.2. After 0.4, the success rate began to decline more rapidly and, if I remember correctly, after 1.0 the odds of success were low. Even at 0.2 the odds of success may only be at 40-50%. However, both scanning and radiation technology is improving and it's possible that the UCSF radiation oncologist can give you a better idea of what the odds are for your particular case. They're also likely to do a better than average job of radiation if that's what's called for.

If your PSA reading was a fluke, for example if blood samples were mixed up or contaminated or someone entered mistaken numbers (none of these are unknown to happen and (I'm speculating) may be more likely than a tissue left behind theory) you can find that out with a new PSA test now. I don't think I'd want to wait 60 days. If there was an error in the PSA test, a new test, especially if done by a different lab, should tell you immediately.

Best of luck.Alan

[Tall_Allen in reply to AlanMeyer]

Maybe this article talks about the study you are referring to:

pcnrv.blogspot.com/2016/09/...

[AlanMeyer in reply to Tall_Allen]

Yes, the study that you explain may well have been what I read.

Dan, do have a look at Tall_Allen's blog posting. It is highly relevant to this discussion.

[ehiker in reply to AlanMeyer]

Thanks Alan. Going to oncologist next Friday..hopefully get another psa and docwhat I have to do. dan

[efsculpt]

I second Tall_Allen's advice. Four years ago I had rising PSA post RP. I was node negative at operation. Got prostate bed radiation plus 4 months of Lupron/Casodex. Cancer came back. Node Negative doesn't mean the cancer hasn't leap froged to farther out nodes. I started Lupron/Zytiga about a year ago, then got whole pelvic radiation at 3 months (minus the prostate bed), still on the ADT for 6 more months. The Ga-68 is the "real deal". Wish I'd had it available when I was post RP. Get information, then decide where to radiate. Add some ADT.

Good luck,

Craig

[ehiker in reply to efsculpt]

Thanks so much Craig. dan