Rising PSA after RALP MSK 8/16/18 Eastham

[sharpcut]

Happy Holidays!!! I am brand new here and dam lucky to find you guys !

I had RALP with Dr James Eastnam at MSK on 8/16/18 MY Pretreatment PSA was 6.23 ng/ml

Post Surgery

Gleason score Primary 4 Secondary 3 Total Gleason 7. Grade Group 2

Clinical Stage. T 1 C NO MX

Tumor Type Adenocarcinoma Primary Tumor pT2 Organ confined

Percentage of prostate engaged by Tumor 15%

Perineural Invasion identified

No Lymph Node or Seminal Vessel metastasis

Post Surgery PSA was undetecable until .....

9/18/19. PSA .07 ng/ml

10/21/19 PSA .08 ng/ml

12/5/19. PSA. .10. ng/ml

Dr Eastham wants me to meet with a Radiology Oncologist Dr Borys Mychalczak. ?? for salvage radiation on Thursday 12/19

Not sure if I have enough data to calculate my PSADT but if the rate continues it will double very quickly so is there an advantage to starting radiation early ?? Or waiting for a higher PSA level and getting a PET scan with fluciclovine/Axumin F18 PET/CT.

to determine where the cancer is !!

I exercise vigorously and hope I am not raising my testosterone levels at all ??

I eat mostly a plant diet with chicken and trying to keep the sweets away !

I have had IBS symptoms starting 3 years ago then My PC began

Still have loose stools But my colposcopy was negative for malignancy

My Father and Grandfather both had PC but past away from other disease

I keep researching and praying for the right way to treat my PC

Not ready for Radiation side effects nor ADT but looking like both are in my future

Any important questions to ask the RO. ???

Thank You !! Having this group is a comfort in many ways Keith

[Tall_Allen]

• PSADT is not validated for PSAs below 0.1, but two consecutive rises over 0.03 or an increase of 0.05 per year, are good indicators that SRT is necessary

• No positive surgical margins?

• Don't wait for PSA to rise further just so you can take a picture of metastases - that is a self-fulfilling prophecy

• If you treat the prostate bed now, you may not need adjuvant ADT or need to treat pelvic LNs

Here are some questions: (adopt to your situation)

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

[sharpcut in reply to Tall_Allen]

Thank You Tall_Allen. Appreciate your time correction- Gleason Primary Pattern 3 Secondary 4 = 7 No Surgical Margins !! No LN or SV metastasis 11 LN clean ..................... Total Printed out questions Ready to see RO in 2 days ! thanks

[tallguy2]

You may also be facing the start of ADT in addition to radiation therapy.

[sharpcut in reply to tallguy2]

yes thank you tallguy2................... will post after tomorrows meeting with RO

[Murph256]

I see today is Thursday 12/19. Please tell what you thought of Dr. Borys Mychalczak. I meet with him for the first time in Feb. Although Dr. Michael Bernstein did my SRT.

I’m beginning to realize that PNI is a big issue.

[sharpcut in reply to Murph256]

Hi Murph256

Sorry for delay Met with Dr. Borys Mychalczak. 12/19 He wanted to be ready to move ahead with Radiation and ADT after my PSA reached .2 (now.1) due to no High Risk Factors from my surgery - Gleason 3+4 ,Clean Margins ,13 Lymph Nodes Negative or Seminal Vessels. Although we did not discuss PNI which I had so go figure ?? He stressed that the velocity of the PSA and PSADT are the most important factors in deciding when to begin Treatment

He we wants to radiate Prostate Bed Lymph Nodes Seminal Vessels

He also wanted to start Hormone Therapy for a month or 2 before Radiation ! ? Feels ADT adds 8% success rate to biochemical control

Imagining He wants to do a CT/MRI combination to see if any Metastasis exists

He is not a fan of Axium Scan says results have been underwhelming

Also He invited me to partake in MSK Clinical Study for PSMA PET imaging for recurrent prostate cancer Although he was not sure insurance would cover it.He also thought it would not show much but might be worth it. PSA must be 0.2

Radiation is IG IMRT

My next PSA is 1/8/20.

This is my first" Run through the jungle" and I feel like "Two hundred million guns are loaded"

My other conundrum is a recent bout of IBS' Symptoms. First Constant Diarrhea and loose stools for the last 2 years now Constipation so wondering if anyone has experienced this and if there are Hospitals the specialize in these hard to fix symptoms

??

I have changed my diet to a Gluten Free Plant Based Diet Cruciferous Vegetables and Mostly Rice. Also taking Metamucil at night with probiotics in morning (ALIGN). Had a Colonoscopy month ago several polyps removed but nothing malignant

(back in 3 years). ............Stool test showed no infection .....................This condition is horrible with no end in sight

I am grateful for your support

Wishing you a peaceful and healthy holiday keith

[Murph256 in reply to sharpcut]

Yes, my DX and prescribed treatments are very similar to what you are describing. Please read my profile.

I have heard that the radiation might exacerbate your IBS.

What was your impression of Dr. Mychalczak?

[sharpcut in reply to Murph256]

Hi Murph256 ,

Not sure what to make of him yet He was thorough Spent an hour with me At this point I am willing to listen to everyone but want to cross refernce Everything I am told ! I liked Dr Eastham yet after my PC recurrence he has little to say and has shown little interest Not sure if that is indicative of Dept Chairs or just the way of the world But I intend to ask every question I can to be my own advocate. What about you ? What was your impression of him ? How did like your RO ?? What have learned that you might have done differently. ?? Appreciate your interest Keith

[Murph256 in reply to sharpcut]

I have not yet met Dr Mychalczak. I thought my surgeon, Dr Laudone was great, and I liked my RO, Dr Bernstein. Dr Bernstein treated me in Westchester, but is now working in Manhattan and on LI exclusively, so I am being passed onto Mychalczak. However, moving forward, I think my real need will be an MO. Did you meet with Dr Teo or Dr Lee?

[sharpcut in reply to Murph256]

I have not I have an appt with Dr Scher 1/18/20 or so

[sharpcut]

Hi

Sorry for delay Met with Dr. Borys Mychalczak. 12/19 He wanted to be ready to move ahead with Radiation and ADT after my PSA reached .2 (now.1) due to no High Risk Factors from my surgery - Gleason 3+4 ,Clean Margins ,13 Lymph Nodes Negative or Seminal Vessels. Although we did not discuss PNI which I had so go figure ?? He stressed that the velocity of the PSA and PSADT are the most important factors in deciding when to begin Treatment

He we wants to radiate Prostate Bed Lymph Nodes Seminal Vessels

He also wanted to start Hormone Therapy for a month or 2 before Radiation ! ? Feels ADT adds 8% success rate to biochemical control

Imagining He wants to do a CT/MRI combination to see if any Metastasis exists

He is not a fan of Axium Scan says results have been underwhelming

Also He invited me to partake in MSK Clinical Study for PSMA PET imaging for recurrent prostate cancer Although he was not sure insurance would cover it.He also thought it would not show much but might be worth it. PSA must be 0.2

Radiation is IG IMRT

My next PSA is 1/8/20.

This is my first" Run through the jungle" and I feel like "Two hundred million guns are loaded"

My other conundrum is a recent bout of IBS' Symptoms. First Constant Diarrhea and loose stools for the last 2 years now Constipation so wondering if anyone has experienced this and if there are Hospitals the specialize in these hard to fix symptoms

??

I have changed my diet to a Gluten Free Plant Based Diet Cruciferous Vegetables and Mostly Rice. Also taking Metamucil at night with probiotics in morning (ALIGN). Had a Colonoscopy month ago several polyps removed but nothing malignant

(back in 3 years). ............Stool test showed no infection .....................This condition is horrible with no end in sight

I am grateful for your support

Wishing you a peaceful and healthy holiday Keith