PSA increased after surgery

[FGSmith]

62 year old had original psa of 30 - Gleason 9 - had surgery and lymph node removal as MRI showed 2 enlarged lymph nodes in the prostate area that turned out cancerous from the pathology report. 6 week check up post surgery and psa was up to 44. It was totally unexpected going from having hope of a possible cure to having advanced stage cancer. I had expected a recurrence sometime because of the lymph node involvement, but not like this. Immediately started Lupron and had a PSMA scan, which showed 2 other lymph nodes in pelvic area being effected, nothing in bones or organs. Now on Zytiga also and follow up in another 3 weeks. Feel fine other than fatigue and hot flashes, and still fighting incontinence. Initial psa test after after 2 weeks on lupron brought psa down to 16, and doctor was encouraged for that drop in a short time. Sounds like this is the standard protocol of treatment reading other posts here, other than possibly of having had surgery. Have had genetic testing completed also, both liquid and tissue. Any advice from personal experiences I should be covering with the Dr? I am being seen at the Simon Cancer Center in Indianapolis.

[Magnus1964]

Sounds like zytiga is working well. There are other ADT drugs if and when zytiga should fail. For now celebrate.

[Tall_Allen]

Have you seen a radiation oncologist? Why are you not pursuing whole pelvic salvage radiation?

[LearnAll]

Once bone or lymph nodes get involved, its classification does change to Metastatic Prostate cancer for which Lupron plus Zytiga/Prednisone is now a days considered standard protocol...so you seem on the right meds and they are starting to work as your PSA is going down now. Hope you reach undetectable PSA level soon.

[tango65]

If the positive lymph nodes are located in the pelvis only you do not have distant metastases and whole pelvis salvage radiation including lymph nodes up to the aorta bifurcation is indicated . You need to consult with radiation oncologists ASAP.

astro.org/News-and-Publicat...

[FGSmith in reply to tango65]

thanks - this will be my topic on next visit in a couple of weeks

[tango65 in reply to FGSmith]

Best of luck.

[monte1111]

No bone or organ involvement is great. I have no advice. I would consider Tall_Allen's advice very carefully. He has a lot of knowledge on the subject.

[RonnyBaby]

I agree with some of the others.

Radiation IMO is indicated for the entire pelvic node area, although I am no doctor.

I was node positive @ Dx ( G9 ) and received the radiation treatment.

Today (1.5 yr. post rad treatment) I appear to be all clear / in remission.

Hopefully, that is something you might achieve.

Best wishes 2 U ....

[Shooter1]

Now how you feel. PSA 53 before robotic assisted RP. 5 weeks later 63. Joined the wrong way club.

[Break60]

Radiation to ALL pelvic lymph nodes is highly recommended!