One year after RP.

[JBum]

One year check with my urologist on Monday. Had RP My psa has gone up at every 3 month check. First was .04 then .05 then .08 don’t know what it will be this time. I’m G9. Contained no svi , no positive nodes, margins clear. If my psa goes up is it considered recurrence? Should I be looking for a RO? What scans should I be looking for? I want to be as aggressive as possible. Can they biopsy the bed to see if that’s where cancer remains? Thank you for any reply’s

[Tall_Allen]

Yes, definitely talk to an RO. No scans or biopsies will be useful at this point.

[JamesAtlanta]

Do you have a medical oncologist who specializes in prostate cancer? If not, I’d immediately schedule an appointment - you want the MO to be the ‘quarterback’ for you, recommending the treatment plan.

Hope this helps! Best wishes on your journey!

James

[j-o-h-n in reply to JamesAtlanta]

GREAT ADVICE <==== LOOK AT WHAT JAMES WROTE...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/18/2019 12:15 PM DST

[Hidden]

Talk to an RO. He will want to do baseline scans. Do it. If you do not have a baseline, how can you compare to down the road if needed. I had nuclear bone scan and soft tissue CT Scan. I had three in 2003, before I went metastatic in 2004. My last one was in 2016.

At this point you are considered undetectable; i.e, <0.1. For most people, ultra sensitive PSA cause more worry than anything else. Consider what Allen wrote, a variance of 20% on ultra sensitive test is normal. Don’t forget that you will always have a minute reading of PSA from sources outside of that which is generated from a Prostate. Having no Prostate does not mean that you will not have measurable PSA.

Case in point: I have four blood draws a year. Since Feb 2010 with no medication they are always <0.1. That is all I care about. If I was a worrying man, readings like yours, would drive me batty and in the back of my mind, re-occurrence.

May you have many undetectables. Don’t forget that three successive rises in PSA usually means failure. BUT that is from 1.0 minimum with rises reaching to 2.0 or beyond. NOT 0.03, 0.05, 0.06...... Hundreths do not count.

GD

[Papillon2 in reply to Hidden]

true

[Ralph1966]

I have a similar situation G9 RRP 2017 (no extension beyond the capsule). PSA undetectable for 15 months then 0.02 0.03 0.05 0.09 monthly check and will have one next week (hopefully not 0.2) In such cinario we will need salvage radiation therapy best done before PSA reach 0.2 and in your case as I did you need a MO who will do a quick scan to locate any recurrence (which most likely will be negative and show no cancer cells) and then send you to RO. I was surprised that the RO said that I need to start radiation even with PSA of 0.09 may be she knows that insurance approval takes time. So go to MO + RO and don't wait for PSA passing 0.2!

[JoelT]

Three rises post surgery is considered a recurrence. Since the scans are negative it is classified as a biochemical recurrence or PSA only recurrence. You can consider having the prostate bed radiated which, if the cancer is only in that area might be eliminated. I would also consider a round of ADT (hormone therapy) given the recurrence and your high Gleason grade.

[JimVanHorn]

I had 42 radiations in 2007 and then my PSA went up to 26.0 in 2011. I had a bone scan and they found metastases round the hip stage 4. I had 30 more radiations and started Lupron injections after 3 weeks of Casodex (to stop a testosterone flair). I stayed on Lupron for 6 1/2 years and my PSA was 0.006 consistently. I stopped all cancer therapy last year in April and on Christmas Eve my cancer doctor called me and told me I no longer have caner in my body. I will see him in June for a follow-up. Keep asking questions and just keep truckin'.

[Break60]

Yes a RO is appropriate. You’re G9 but with better prognosis than I was with SVI, ECE, pos margin. I waited for two successive Psa tests of .2 which was SOC in 2013 before starting SRT. Having it earlier is better and hitting all pelvic lymph nodes as well as prostate bed is important along with ADT.Be sure to find a RO who knows how to use IMRT on pelvic lymph nodes !

Bob

[RonnyBaby]

It sounds like something might have been missed to react the way U have.

It happens far too often IMO after RPs, that people report a rising PSA, post surgery.

The PSA doubling rate is the key to monitor the disease (castrate sensitive).

I think further testing is in order.

It's also important NOT to panic.

You have a lot of road ahead of you and there's lots in the toolbox to fight back.

Note that I was G9 and node positive. Today, I am undetectable, 2 years past after RT and ADT.

We wish you well ....

[j-o-h-n]

GREAT ADVICE <==== LOOK AT WHAT JAMES WROTE...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/18/2019 12:15 PM DST