Post VMAT - What Questions for CR

[StuartS]

Situation age 72 Based in UK (Scotland): Gleason score 3+4 - 7. Biopsy was 12 core with 8 targeted. Results were targeted 8 = 4 positive - General 4 = Nil positive. Noted as Stage T3a. PSA 33.2 but no mets and MRI/Bone Scan and x-ray all show no indication that PC has spread other than bulging of the capsule.

Started formal treatment in December 18 – was advised that cancer was Locally Advanced - Treatment started with 3 weeks of Bicalutamide then overlapped with Lupron with a one month injection late December and a 3 month injection in late January. This followed by 3 month injections in Apr and Jul 19. Mid-term bloods in late Feb showed PSA dropped from 33.2 to 3.1, so appears Lupron is working. Latest bloods in mid Mar showed that PSA had risen slightly to 3.7, but Consultant Radiologist (CR) not too worried (dead cat bounce!) and recommended that we continue with next stage of treatment.

Treatment mapped out as VMAT (RapidArc) which I completed last month. This consisted of 22 treatments resulting in 60 Grey over a four week period. Last session was 4 Jul 19.

Had my latest blood tested 19th Aug, details of which I will receive when I meet next week with the CR on 26 Aug 19.

When I get my results, what numbers of PSA and T should I be looking at that would indicate that things are under control post VMAT? What level of PSA should I be relaxed about and at what level should I start to consider additional treatment – Brachytherapy etc.? Is there anything else I should be asking the CR At this stage???

As always..., thanks in advance for any and all contributions

[Tall_Allen]

You should be on Lupron for about 2 years after your RT. While on Lupron, your PSA should hold steady. You won't know if RT was successful at getting it all until after the Lupron is done and your testosterone rises back to normal. You just have to wait and see.

You can't have whole-gland brachytherapy now - you've had too much radiation for that.

[StuartS in reply to Tall_Allen]

Hi TA..., Many thanks. Appreciate again your prompt response. If bloods indicate PSA or T is raised what are my options likely to be?

[Tall_Allen in reply to StuartS]

There's no reason that your T should increase. If it does, you may need a different hormonal therapy. If your PSA goes up and your T stays low, ignore it - bounces are common.

[StuartS in reply to Tall_Allen]

Hi TA...,Thanks again. Always reassuring to get input from those in the know.