First PSA rise in three years, watch for doubling time? Or look into scans?

[cajeffrey]

My husband (age 71) was diagnosed in Feb 2017, PSA 275, gleason 8, There were several enlarged lymph nodes in the iliac chain, obturator, and largest in the para-aortic measuring 3.3 cm. Bone scan was clear. Pelvic radiation in 2017. After 3 months of ADT (eligard) his psa dropped to .008. After 18 months of ADT, his RO took him off ADT, saying that this is SOC. His psa remained at .008 until his last test on Mar 4 2020 which was .023. Recent ct showed 3 small nodules in lungs and recommended to recheck in one year. 2 cm lesion on ilium (not biopsied) found on earlier ct unchanged. I realize this is a very small uptick, but it is concerning. Do we remain patient and check the psa every month to see if it continues to rise? Or are there some scans that we should look into right now? Are there scans which can detect activity at this low level of PSA? I know it has been covered in previous posts, but each persons case is unique. And another question, should he go for another line of systemic such as Abiraterone (zytiga). I apologize for all of the questions, but we have been coasting for the last three years (and feel very lucky) and I feel we must be prepared for the future. By coasting, I mean tolerating radiation side effects, ADT side effects, spinal surgery, coronary artery stents, but we are still here making the most of each day and being thankful for every one and never giving up! Your stories and perseverance are an inspiration. Thank you for all of your knowledge and for taking the time to share. It is so much appreciated!

Catherine

[Tall_Allen]

Unfortunately, your husband is in an understudied situation - diagnosed with positive lymph nodes and treated with RT+ADT. That situation is discussed in this article:

pcnrv.blogspot.com/2016/08/...

It is entirely possible, that his treatment has been curative, and no further treatment is necessary. You will only know with patience (which is infuriating).

It is expected that PSA will rise after ADT wears off because he still has a functioning prostate producing PSA. If it rises over 2.0 (biochemical recurrence), then it may be time to do some imaging. Even if there were scans that could detect cancer at such low PSAs, I'm not sure what it would mean; it takes some time for all the irradiated cancer cells to die (it took 3-4 years for me). They are like zombies meanwhile - incapable of life - dead without "knowing" they are dead. So I'm not sure what, say a PSMA PET on a zombie cancer cell would mean.

Good idea to CT those lung nodules in a year - most likely they are benign, not prostate cancer. Lesions, like the iliac one, that don't shrink on ADT are usually not prostate cancer.

[cajeffrey in reply to Tall_Allen]

Thank you so much for your informative reply. And thanks for the referral to your blog , there are many postings there that I intend to read.

I agree that it is difficult to find definitive studies showing advantages to RT+ADT. It is my understanding that my husbands stage would be M1a and therefore not in most study categories of no distant metastasis. According to BC Cancer, regional lymph nodes are the pelvic nodes below the bifurcation of the common iliac arteries and so the Paraaortic lymph nodes are considered distant metastasis. I don't know how relevant this is in outcomes.

An MRI of his spine (while his psa had been at .008 for over a 18 months) showed a very slight decrease in the size of the enlarged lymph nodes. So even though they are still enlarged, the cells are most likely dead or dying?

At diagnosis his RO had said that there is no cure, but three years later he said that the treatment might be curative. Needless to say, we are confused!

Your advice of having patience is probably the best advice we can have, but as you say infuriating.

Catherine

[Tall_Allen in reply to cajeffrey]

You are right that the paraaortic LNs are technically outside of the pelvic region. But since they were irradiated, there's a chance it hasn't traveled farther.

[cajeffrey]

Thank you so much for your reply. That is great advice re: don't get PSA crazy. I just talked to my husband about this, and we are going to do our best to "leave it alone and not obsess". Basically make the most of each day, and monitor monthly. (With spring weather around the corner here in Ontario Canada he can focus on getting our small sailboat ready to go in the water.)

I wish he would follow your example and get to the gym once in awhile! Your results are quite impressive. All the best to you.

Catherine

[Hidden in reply to cajeffrey]

Catherine APC fromA-z is anxiety and confusion. Some of these men have lived for decades with APC and it treatments. I was told that I’m cured but then I’m still on adt ..

[Hidden]

I understand exactly. We’ve been coasting over four years .. many prayers to you both in whatever comes next . Scott

[cajeffrey]

Thanks for your reply Whimpy-p. I agree, anxiety and confusion come with the diagnosis. Cured? Not cured? I don't think there is ever a definite answer to that. My husband's RO said that his job was to make sure he died from something else. Not the best bed side manner, but I get what he meant.

All the best to you

Catherine