My first post. Rising PSA After Surgery.

[Polaris1]

Thanks to all of you who are sharing your knowledge and your experience.

My PSA has risen from 0.21 to 0.53 since surgery. Axumin PET scan 5/23/19: one small pelvic lymph node on left side. RO is recommending 4 months ADT (Lupron + Casodex) and 38 sessions of PBRT (Prostate Bed Radiation Therapy) at 68.4 Gy, 25 sessions of PLNRT (Pelvic Lymph Node Radiation Therapy) at 50-60 Gy.

Is this the best approach for my situation?

My profile: July 2018: PSA 14, diagnosed with PCa via biopsy, Gleason 8. No symptoms. DRE and MRI indicated right side EPE. CT and bone scans did not indicate other involvement. October 2018: had robotic laparoscopic prostatectomy at University of Chicago Medical Center. Nerve-sparing surgery on left side. Wide margin on right side but still had one 1 mm positive margin on right side. Confirmed Gleason 8. 15 lymph nodes removed - no PCa. Post-surgery PSA levels:

12/24/18 0.21

1/24/19 0.21

4/2/19 0.32

5/23/19 0.53

[Fairwind]

Your surgery has failed...It's called "Persistent PSA" and RT is your next option. It sounds like your RO has an aggressive treatment plan. I would ask if the RT can't be combined into a single treatment instead of two separate treatments.. The new LINACS (radiation machines) can be programmed to do this sort of stuff...Today, that single lymph node can be zapped with just 5 sessions of SBRT ..

[Shooter1 in reply to Fairwind]

Mine went from 52 to 62 in 6 weeks after surgery,. ADT, Taxatere, and Xtandi. PSA 0.120 now. Been 0.140 or less for last year. RO my have right answer for you, but I had no targets for radiation. Full spiderweb of G 9/10 through out ab and against rectum and other vital organs. Best of luck.

[Polaris1 in reply to Fairwind]

Thanks. My RO confirmed that the PBRT and PLNRT are combined.

[Hidden]

Looks like a good plan to me although I think the general recommendation is a longer time than 4 months on ADT for best chances of long-term remission. Something to look into and/or discuss with your doctor.

[NPfisherman]

I would be on ADT for a longer period....18 months to be on the safe side (at least)....I have seen people shorten the ADT due to side effects and that can come back to bite you... I would get a 2nd opinion and then decide....Good luck....

Fish

[Tall_Allen]

Yes, that is definitely the best treatment. My feeling is to go a little higher on the prostate bed dose (my RO routinely gives 72 Gy). Also, make sure they are planning to irradiate an expanded pelvic LN field (up through the common iliac nodes) and not just the "RTOG" field (your RO will know what that means).

[Polaris1 in reply to Tall_Allen]

My RO said the pelvic lymph node radiation would be up to L4 - is that the same as up through the common iliac nodes?

[Tall_Allen]

Yes - it is even higher, which is good. I think that because you have a known positive lymph node, ADT should continue for at least 2 years. I suggest you discuss the following with your RO:

pcnrv.blogspot.com/2016/11/...

[garyi]

My PSA was similar to yours, shortly after surgery, and I had 39 sessions of 1.8 Gys each. So far so good. Sounds like your RO knows his business. Good luck.

[Hidden]

Persistent PSA 20 post surgery. I went on Lupron then 38 rounds of rad when it was safe to start. PSA dropped to below 1.0 6 months post surgery. Stayed on Lupron for 12 months before taking my first break.

[JavaMan]

That path is what i understand to be best. I am on a similar timeline as you but with some better stats - gleason 7 and lower psa following surgery last Fall. Wrapping up radiation next week and am on a 6 month ADT plan. Best of luck to you!

[RonnyBaby]

Pelvic lymph node treatment is probably a good move / next step in your push back against this disease.

I had some pelvic radiation done as part of a greater overall RT strategy (and ADT combo).

The side effects (RT) were minimal, although the fatigue was surprising and I certainly underestimated how much. Note that I was a G9.

That was about 2 years ago. I reached an undetectable nadir within a few months and I'm feeling stronger and better as time goes on.

It sounds like you are on the right path with an awareness that is important as you move on.

We wish you well ....

[PGDuan]

I also had persistent PSA. As others noted, most studies suggest longer ADT with the radiation in hopes of a possible cure or longer term remission. My doctors are recommending 18 months based on the latitude study, although we take it one 3-month shot at a time. We also added Zytiga and the higher doses of radiation like Tall Allen suggested. Ever since I started my post-surgery treatments my PSA has gone from 4.0 to 0.37 to <.01 in 8 weeks. Talk with your medical team and best of luck. The treatments aren’t fun, but they are not the end of the world either.

[Polaris1 in reply to PGDuan]

Thanks to all who have provided feedback.

Several of you have advocated considering a longer course of ADT. I think the four months of Lupron + Casodex prescribed by my RO is probably a starting point and will be evaluated as the ADT and SRT treatments proceed. My sense is that ultimately the decision to stop or continue ADT at four months will be made based on balancing the probability of longer time to recurrence, metastasis, and survival with QOL considerations.

Regarding the idea of higher radiation doses, I will discuss this with my RO.

[j-o-h-n]

My path also.....

Old post of mine.

C A U T I O N

I've had 39 treatments (8 weeks, 5 days a week minus 1 day). I did NOT have any side effects during the actual "FRYING". However years later it was discovered that my left urinary tract has become scarred/constricted and required many "in and out stents" for my kidney and urine. BTW the in and out of the stents were "a walk in the park". No Pain or discomfort. Rad was done at Memorial Sloan Kettering cancer center in NYC in 2005. After not having a stent in my tract for a few years my Urologist went in to see what's happening. This procedure was done based upon routine CT scans and a scheduled Ultrasound prescribed by my Urologist. So in went a stent (he also added one in my right side for a kidney stone in my right Kidney).

ALL STENTS REMOVED!!! <====<<<

Just be wary of the damage that Rad can do (even if it's silent).

P.S. One plus was that my naive blow up doll felt the left stent while we're dancing.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 06/05/2019 7:29 PM DST

[kcc9993]

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