PSA went from undetectable to 0.2 7 years after prostate removed

[bigpapajd]

My husband is now 52 and 7 years ago he had early stages of prostate cancer. He decided to have the prostate removed and after surgery his PSA has been undetectable until now. His PSA went to 0.2 in 6 months and his urologist said she recommends radiation to treat it. We have an appointment on Oct. 9 with the radiology oncologist. Does anyone have similar experience? What questions should we ask when we meet the doctor?

[Fairwind]

Many, many of us have suffered this setback..I would expect one of the newer scanning techniques be performed to try and locate and isolate exactly where the cancer is . Salvage radiation might be more effective if the exact location is known.. Radiation treatment has come a long way over the past 10 years or so today it's far more effective and less damaging than it once was. There is still a good chance a cure can be achieved..What was hubbies Gleason score when he was first diagnosed 7 years ago...?? This will play a part in how aggressively he will be treated now..

[bigpapajd in reply to Fairwind]

I am not sure. I will look back in his medical record. What type of scanning can locate where the cancer is? CT scan?

[Tall_Allen]

Here are some questions to ask (adapt to his situation - for example, Decipher isn't relevant if he was treated 7 years ago):

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

Was he Gleason 6 when he was first treated?

[bigpapajd in reply to Tall_Allen]

Thank you for the questions. This is very helpful!

[bitittle]

Yes...similar story for me as a Gleason 9 at 49 yrs. old. Had a prostatectomy and 2.5 yrs later PSA rose to 0.182. I had 38 radiation treatments to prostate bed only. For the last 2.75 yrs psa is undetectable. Still rising ever so slowly on my ultrasensitive psa tests, but considered undetectable. Good luck!

[bigpapajd in reply to bitittle]

Thanks bitittle. Good luck to you too!

[Firespooks]

Sounds like me . Had mine out in2006. Stayed undetectable until 2013. I was at 0.22 . Had 39 radiation treatments to my prostate bed. Again went undetectable. Now I’m back up to 0.22 again. We’re watching and waiting for now.

[bigpapajd in reply to Firespooks]

Did they run tests to see if it had spread to bones or other areas?

[4020jd]

Similar story. My husband's was found at age 42. Remove by Davinci. 5 years later .2 . Life got messy with family and he missed getting blood tests for a few years. 7 years post surgery PSA 1.6. Did 40 radiation to prostate bed. Didn't cure, but lowered back to .6. Best of luck.

[bigpapajd in reply to 4020jd]

Thanks. Best of luck to you too!

[Gemlin_]

If it was me, I would ask about:

- radiation of the pelvic lymph nodes

- benefits and harms with ADT (androgen deprivation therapy) added to the radiation.

Good luck!

[bigpapajd in reply to Gemlin_]

Thanks. I will add to my list for the doctor visit next week.

[TEBozo]

I had mine removed and then 6 months later IMRT.

[bigpapajd in reply to TEBozo]

Did your PSA go to undetectable after radiation?

[TEBozo in reply to bigpapajd]

A month after IMRT, <0.05

[humptedumpte]

Has the PSA been repeated?

[bigpapajd in reply to humptedumpte]

No, we just got the results on Thursday. I was thinking of that too. I will ask his urologist.

Thanks.

[Hidden]

My excel, derived from the Heidelberg paper, shows some favorable detection probability for PSMA PET/CT detection.

This is due to his younger age and shorter PSA doubling time.

You write that "went to 0.2 in 6 months", hence, I gather he falls into the 31-90 days PSADT group.

Under these conditions a high (for the 0.2 PSA) probability is returned: 72%

In your husband's position I would go for the PSMA PET/CT just before the irradiation start.

Any positive PET detection can and will change the overall RT planning.

Good luck

[bigpapajd in reply to Hidden]

Thank you for the detailed information. This is very helpful!

[Hidden in reply to bigpapajd]

You are most welcome.

If you will follow this parh please report back, as it is my plan for me.

Approx. 50% of RTs ultimately fail because the source of the PSA advancement was out of the irradiation target. One just learns this after some years (if combined with ADT) and after having received useless and possibly harmful irradiation.

Lastly, in a case where the source is detected in a lymph node, the possibility of a salvage lymphectomy is yet another weapon in the armory.

[bigpapajd]

Update: prior to surgery in 2012, my husband's Gleason score was 6 and his tumor was stage pT2c.

[j-o-h-n]

I had the 39 sessions of radiation to the prostate bed after my RPD. PSA went down and then up again. Remember there is no cure just treatments from now on.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 10/07/2019 12:03 AM DST

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

I am learning that it only goes into remission and not cured from this website. Thank you for your comment.

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

You're quite welcome... sit back and relax...Plenty of room in the boat....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 10/07/2019 6:32 PM DST

[Emak1]

I was/am in a similar situation. Had surgery at 43, reoccurrence at 45. Did 40 radiation session over 8 weeks and had 7 months of ADT.

My pathology was GL7(3+4), PSA was 0.28 at time of ADT shot. Wrapped up July 2018, Testosterone has been normal since Sept 2018 and still undetectable.

Is it cured, don't know (next PSA is December). The folks at Sloan Kettering were talking curative vs. remission. I think there are cases to made on each side. Given you are GL6 and it took this long to return (7yrs), you have a shot at a cure or a very long remission.

Here is a calculator to see the statistics of salvage outcome based on your profile

mskcc.org/nomograms/prostat...

[bigpapajd in reply to Emak1]

Thanks for the link. Your situation sounds very similiar. We have our first consultation with radiation oncologist on Wednesday. I am getting my list of questions together and have learned so much from the caring people on this site.

[Emak1 in reply to bigpapajd]

This site is great. Lots of knowledgeable people. Don’t be afraid to ask questions to the oncologist. But the radiation procedure is not that bad. Just logistically lots of sessions

[daleboy3]

Can I suggest you read the following link

nattokinasehearthealth.com/...

[GeorgesCalvez]

You have to remember that statistics do not apply to the individual but to the group.

Your sample size is one and you have your own unique attributes that may result in you doing significantly better or worse than the average member of the group.

That is why some men stop responding to ADT after a few months and others roll on for years, etc.