two years ago my husband (then 54) was diagnosed ductal adenocarcinoma, gleason 7. His PSA had always been super low (the highest was at his diagnosis, at 1.8), and the cancer was discovered on a physical exam. Bone scan, cat scan and MRI showed no metatases, and he opted to go with brachytherapy and external beam radiation. His PSA immediately fell to 0.5. but then a year or so ago, went up to 1.7. The subsequent reading was down again to 1.4 and then last week it was up to 1.7 again. His doctors want to rule out recurrence and have ordered a PET scan, bone scan and MRI. I'm wondering if all of this seems reasonable? I'm utterly terrified as I just lost my father to heart disease and my best friend to breast cancer and am having a difficult time figuring out how much I'm supposed to worry now.
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CrowMama
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I was also diagnosed with ductal one year ago at 54. I've had all those test and my PSA was NEVER over 3.6. I was told by MD Andrerson. Thats how they will mostly monitor him.Men with ductal use imagining as instead of PSA...
As for "how much I'm supposed to worry now" ?..
I've given ALL that to God to take care of... I just live
A recurrence in his case would be a PSA above 2.5 ng/ml, so not yet. You could wait for that if insurance does not pay for all these tests. For a PET test I would suggest an Axumin scan.
As far as I know, the HDR brachytherapy should have destroyed the ductal cells so do not worry about that.
Unfortunately, ductal is one of the types of prostate cancer where PSA is a poor biomarker of progression. I'm not sure which, if any, of the advanced PET scans (PSMA, Axumin, or Choline) is useful. You may have to rely on the FDG PET scan/CT to track progression. Another tool may be a Cellsearch (Circulating Tumor Cell) analysis. A doctor today told me that he has gotten insurance to pay for a Guardant360 Analysis of cell-free DNA. It normally costs about $5000 for the first and less for subsequent ones. If your insurance will cover it, it may become a useful tool in tracking progression.
Your husband is very lucky the cancer was caught early. I am also ductal, and had normal PSA tests for several years. After developing symptoms, my PSA was at 216. Ductals can have high PSA, but apparently that happens after it has metastasized and reached critical mass.
High PSA is always bad. Low PSA may or may not be good. Scans sound reasonable, and are something I need to discuss with my MO today.
I am ductal ..part of the .04 percenters..psa at d x was 12 but had doubled from 6 in 2 mos...2 mets so still have pros. I was lucky to get in the Titan trial and they just unblinded it and found out I was on a apalutamide for last 18 months and will continue till death do us part at 12 Grand a month I'm blessed to get it for nada us doctors do have the aggressive form so it's more important to enjoy life
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