Rising PSA after RP Hormone and Chemo

[Ian54]

Hi All

I am 65 years old, Brachytherapy Sept 2014 Gleason 3+4 PSA 8.5, July 2017 Salvage RP Gleason 4+5 PSA 9.0 positive 13/22 lymph nodes and seminal vesicles, LHRH hormone therapy Sept 2017, Docetaxel 6/3 March 2018. PSA post chemo 0.2 then 0.5 Dec 2018 0.9 Jan 2019, 2.5 April 2019. Had PET scan December 2018 and PSMA PET January 2019 at London Clinic still nothing shown even with PSA at 0.9 at time of PSMA PET.

Been referred for another PET scan with view to changing hormone/radiotherapy assuming they can see it with PET CT. It seems now castrate resistant.

I also have Non-Hoskingson Lymphoma stage IV

Throughout not has any symptoms, other than still incontinent and impotent

Royal Surrey say until they have proof it has metastasis I don't qualify for any trials. Seems obvious to me given I had RP and have rising PSA.

It seems when I think I am out of the woods back I go in. Any views on options.

[Magnus1964]

Although your non hodgkin's lymphoma complicates things, having undetectable Pca other than PSA is not unusual.

I had undetectable Pca for decades. There are or were trials for patients without detectable metastases. I have been on 2 of them. Do your own research.

[Hidden]

Are they offering second-line ADT such as Zytiga or Xtandi? There is also Apalutamide for non-metastatic, castrate resistant PCa.

[Ian54 in reply to Hidden]

Thanks for info PSA now 2.9 which is a rise of 0.4 in a month.

[Ian54 in reply to Hidden]

That could be next solution if Pet Scan does not reveal location. My feeling is if we can see it hit it hard with radiotherapy which stampede suggest shows best outcomes.

[Hidden in reply to Ian54]

I didn't know you could get salvage radiation after brachytherapy.

[Ian54 in reply to Hidden]

When the brachytherapy failed my prostate was removed which is called salvage radical prostatectomy.

The radiotherapy will be targeted if and when it can be seen on a scan. Ian

[Hidden in reply to Ian54]

Ok thanks. Salvage radiation therapy after RP is often not targeted, just given to the prostate bed.

[NPfisherman]

Ask them to consider a Chromogranin A test for neuroendocrine since the PSA is low, but rising. and also genetic testing to look at mutations....

All the best,

Don Pescado

[Ian54 in reply to NPfisherman]

Hi Don

I will look into this not come across this treatment, have you undergone the treatment. Ian

[GP24]

The PSMA PET/CT was done too early. Four months later, with a PSA value above 2.5, you can be almost sure that metastases can be detected. If possible, just do a PSMA PET/CT now.

Here are the probabilities for detecting metastases:

"The detection efficacy of 68Ga-PSMA ligand PET/CT was

96.8% for a PSA value of ≥2 ng/mL,

93.0% for a PSA value of 1 to <2 ng/mL,

72.7% for a PSA value of 0.5 to <1 ng/mL, and

57.9% for a PSA value of 0.2 to <0.5 ng/mL."

jnm.snmjournals.org/content...

If nothing shows up, you may be PSMA negative and you could try a Choline PET/CT instead. Better wait for an even higher PSA value for that. After you arranged for the next PSMA PET/CT and got the results, your PSA value will be high enough for a Choline PET/CT. E.g. 5 ng/ml.

[Ian54 in reply to GP24]

Hi GP24

Thanks had hoped I might fall into the 72.7% PSMA success rate at PSA 0.9.

If this PET CT does not show anything will go back for another PSMA and hope I’m in the 96.8%. Ian

[Tall_Allen]

Have your pelvic lymph nodes been irradiated?

[Ian54 in reply to Tall_Allen]

Hi Tall Allen

Not had any radiation yet. Ian

[Tall_Allen in reply to Ian54]

That would seem to be a good next step. Where there are some positive lymph nodes, there are undoubtedly more.

pcnrv.blogspot.com/2017/12/...

Talk to a radiation oncologist.

[Ian54 in reply to Tall_Allen]

Thanks will talk to Oncologist on Monday

[Ian54]

My first treatment was Brachytherapy which failed. This was followed up with Radical Robotic Prostatectomy which assumed the cancer was contained. In fact it had already moved outside to lymph nodes and seminal vesicles which were at the time thought to have lymphoma.

Hope this explains

[j-o-h-n]

To Ian54,

Just a note about Non-Hoskingson Lymphoma stage IV. My wife's friend (stage iv) was treated with chemo for his N-HL (for I think 2 years) and then was treated with the Immunotherapy drug Keytruda (for 2 years?). All of his treatments were in Australia and his N-HL is in total remission. That's all the info I know but hopefully it may be useful to you.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 05/31/2019 6:40 PM DST

[j-o-h-n]

I failed to mention that I am taking Keytruda for my lung melanoma and it's working.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 05/31/2019 6:43 PM DST

[Hirsch]

Incontinent from radiation?

[Hirsch]

Sorry. Read on and saw you had a rp

Good luck