PSA rising

[Armywifedublin]

Husbands PSA just came back he’s been undetectable for a year now is 0.15 last was 0.03 please what does this mean???

What now I’m scared...

[Armywifedublin]

He tests every 3 months.

We see a Dr in New York but we are not scheduled to see till Oct he’s calling Tomorrow.

Does this mean he goes back on ADT?

I also messaged you..

What is BCR.

He’s had genetic testing g he does not have the aggressive type. I do know that .

And they did think it was regional and hit the pelvic area w radiation at The James here in Ohio last June he did 49 rounds of radiation and was on ADT up to January and that was a six month shot that was given then we saw them in April and again now in October.

I’m so upset!!!

I went off the site because I kept reading of men dying all the time

[BarronS in reply to Armywifedublin]

It's too early to tell right now if anything is going to happen. They'll most likely want to see him in a few weeks to get his PSA re-checked. If his PSA starts to go up, they are most likely going to put him back on ADT.

I don't think you're going to be able to see anything present on any scans with that low of a PSA, but it might put everyone's mind at ease if they give him a CT/PET scan.

I know it's very hard, but try to not get yourself so upset as of right now. You don't have all the information in front of you to really see what is going on.

The best case scenario is that it was just a small bump upwards and he stays at that for the rest of his life.

The worse cases scenario is that there are still some PCa cells present and some ADT will knock them back down. That's still a very, very, low PSA reading.

[Fairwind]

Did he ever have surgery? If so, what was his Gleason score revealed by the post-surgery pathology? How old is he ?

[Tall_Allen]

From your previous post, I gather he has already had full pelvic salvage radiation. If his PSA is confirmed, the remaining question is when to start ADT. If his PSA in 3 months is over 0.2, he may be able to get an Axumin scan (if it is available in Dublin). If positive, he should begin on ADT then.

[Armywifedublin in reply to Tall_Allen]

Yes he had radical prostectomy Jan 2018. Followed by 40 rounds of radiation and Firmagon and ADT prior to radiation last ADT was a six m shot this past Jan2019 followed by undectables PSA till today.

Gleason was a 3+4,

PSA at diagnosis was 2.5 then 3.2

After surgery Dr Klein of Cleve Clinic informer is only 25 percent of his Prostate had cancer it grew on the margin of the gland and 3 out of 6 lymph nodes in the pelvic region on right side had cancer left side was clear along with clear seminal vesicles.

Scans have all been clear last done a year ago.

Genetic testing showed his was not of the aggression type per Dr Klein st the Cleve Clinic.

We follow Dr. Dan Daniella at MSK in New York and as I stated last visit was in April and they told us the ADT shot should wear off by July his Testerone is slowly returning and they scheduled a follow up in six months which is Oct 8 in New York.

We are calling their office tomorrow to see where to go from here.

Stephanie

[Hawk56]

Some thoughts since my situation is similar.

I was diagnosed in Jan 14, PSA was 2.1. I had surgery in March 2014. Pathology report was “excellent,” T2CNoMx, GS 4+4, margins, seminal vesicles negative ECE. Still, with the GS8 I knew I was at risk for recurrence.

After 18 months of PSA <.1 my PSA came back at .2 in September then .3 in December. I did salvage radiation in March 16, 39 IMRT, 70.2 Gya. There really wasn’t an imaging option at the time for that low of PSA so the SRT was to the prostate bed, the standard of care...90 days after completing SRT my PSA was .7, we checked again 39 days later and it was 1.0!

I learned that Mayo had been collecting data about the location of recurrence and more often than not it was not confined to the prostate bed but in the pelvic lymph nodes too. Even then the standard pelvic lymph node radiation treatment fields missed locations Mayo identified in their study. I also asked my medical team about doing six months of Lupron in conjunction with the SRT as I had seen recent studies demonstrating longer progression free survival. They said no, the data was not “mature!”

So, in January 2017 we went to Mayo for the C11 Choline scan and consult with Dr. Kwon. Four pelvic lymph nodes showed up in the scan, fortunately no bone or organ involvement. My PSA at that point was 3.8, doubling and velocity times indicated a very aggressive cancer. We elected to do six cycles of taxotere, 18 months of Lupron and 25 more radiation treatments. My PSA dropped to <.1 and stayed there, same for testosterone at <3.

We finished treatment in May 18 with the last 90 day Lupron shot. In October PSA was <.1 and T at 135. In Feb T was 482 but PSA came in at .386, we rechecked two weeks later and it was .125, eight weeks after that .05 then another 8 weeks .126. We will check again in early August.

Is my cancer back, yes..however, not enough data to make an informed decision about treatment. Rather than a sine curve we need to see a continuous upward trend and be able to gauge doubling and velocity. We will image, probably using the Aximun scan here in Kansas City rather than making the trek up to Mayo. The Aximun scan may be more sensitive at lower PSAs.

If my PSA stays in the sine curve mode we will just monitor. If it goes up continuously we will determine doubling and velocity. My medical team is divided about when to image, radiologist wants to at .4, urologist thinks higher. One thing we all agree on is somewhere between PSA 2-4 we will decide on and initiate treatment, the history of my cancer says treat early and aggressively, try to keep it out of the bones and organs longer.

Given what you say about his surgery I am not surprised about the recurrence. It may be time to adjust thinking from “cure” to chronic disease management. I think in 3-5 year windows now, not 15-20 (I was 57 when diagnosed, 63 now). Given the rapid development of imaging, new drugs, more precise radiation treatments both the radiation itself and the software that is used for the treatment as well as emerging immunotherapy I just need treatment that has an ability to control my cancer for the next 3-5 years until newer treatments come into play. Of course if that medical breakthrough comes...sign me up!

I use the analogy of AIDS, once a fatal disease, now with an array of drug regimens and combination therapies, less so.

So, yep, it’s back, have a proactive plan in coordination with your medical team to collect clinical data, labs, imaging, explore treatment options and decide on your triggers to reinitiate treatments, likely combination therapy, such as Lupron with or without Zytiga, can you radiate what the scans find... what criteria will result in stopping treatment, PSA undetectable for a determined time, if you stop treatment again how will you monitor during the “holiday!?”

I am enjoying my holiday from treatments, I expect the future holds going back on treatment but I am confident in managing this as a chronic disease and live my life.

Kevin

[Hawk56]

Not exactly why you asked it my have some relevant information- cancernetwork.com/prostate-...

[j-o-h-n]

Are you in Dublin Ohio or Dublin Ireland?

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 07/15/2019 8:26 PM DST

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

Dublin,Ohio

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

Thanks for the reply... Buckeye state.... ever see a buckeye tree?

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 07/17/2019 6:03 PM DST

[RCOG2000]

Once psa is above 1.0. Axumin scan has sufficient sensitivity to detect disease location.

PET and CT not sensitive enough to very very low volume disease. So a good result on these may be misleading

[j-o-h-n]

Thanks... Now I know not to speak to you in Irish....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/16/2019 11:04 PM DST