I was born in 1967.The PSA in August 2020 is 10.75
I was diagnosed with cancer in September 2020. Prostatectomy and extended lymphadenectomy performed on December 8, 2020. in OLV Aalst Belgium, prof. ALEXANDER MOTTRIER.
Gleason score 7 (4 + 3).
pT3b pN1 pMX.
January 14, 2021 PSA 1.18
January 25, 2021 I received LHRH reseligo 10.8
February 1, 2021 PSMA PET SCAN
There is a left posterior obturator lymph node with increased tracer uptake (SUV max. 17,8; approx. 1,0 cm transversal diameter) anteriorly to the internal iliac vessels. A focal uptake of tracer is noted medially to the right psoas at the level of L5-S1 transition, where there is likely a small soft tissue oval structure (up to 0,5 cm in transversal diameter). There is focal uptake of tracer (SUV max. 11,6) in a small aortocaval lymph node (transversal diameter of 0,5 cm) at the level of L3-L4 transition; faint uptake can be noted in an additional small aortocaval lymph node (SUV max. 5,3; 0,4 cm in transversal diameter) approximately at the level of L2-L3 transition. There are no lesions with increased uptake of tracer in the skeleton and bone marrow.
CONCLUSION: There are no clear scintigraphic signs of residual disease/relapse in the prostatic bed; minimal uptake posterolaterally to the left behind the bladder neck? - ev. correlation with MRI. There are several metastatic lymph nodes noted: left posterior obturator lymph node anteriorly to the internal iliac vessels, right medial to the psoas muscle (level of L5-S1 transition), aortocaval (level of L3-L4 transition), likely another aortocaval lymph node (approx. level of L2-L3 transition). There are no scintigraphic signs of distal progression elsewhere
08.February 2021, PSA 0.53
I go to the oncologist again to see if he will recommend radiotherapy to me. What do you think if you do radiotherapy of the whole pelvis or target metastases? If you have tips for further treatment please help me. Thank you.
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Whole pelvic, definitely. There's a lot more there than you can see in the PET scan. A recent analysis from Mayo suggested better outcomes with whole pelvic salvage treatment:
Your reply brings up an issue in my own case, about which I've often wondered. 2 and 1/2 years ago, (and, 12 after RT), my PSA rose from .04 to .12 (then, .14, .16, .18) eventually settleing and bouncing between .08 and .16, mostly.
I was PT3b with positive margins gleason 3+4 . My psa after RP was .011. Had adjuvant RT (whole pelvic) together with 50 mg bicalutamide. PSA 1 month after aRT was <.003 . My MO recommended to continue the 50 mg bicalutamide adt for least 2 years. Is the 50 mg bicalutamide enough for the adt? Am I still capable of cure?
In fact, the bicalutamide may not be needed at all when one gets salvage radiation at such a low PSA. I hope you understand that you are in a very different situation from the OP, who has lymph node metastasis. You had no detectable metastasis.
From Philippines. Age 49 when diagnosed at Feb 21, 2020 psa 7.41 gleason 3+4 biopsy 1.5T MRi revealed contained within prostate left lobe only measuring .6x1cm. Had open RRP last March 19, 2020. Pathology result: gleason 3+4 with EPE, surgical margins and SVI. PSA after 10 wks (May 2020) is .011 then after a month June 2020) psa is .055.Had CT and bone scan which were clear. Then had EBRT (whole pelvic) started in July 2020 (35 sessions with 70 gy) and started 50mg bicalutamide in Aug 2020. Sept 2020 Psa <.003 MO told to continue 50mg bical for at least 2 years. Dec 2020 psa still <.003 and testosterone is 8.77 ng/ml (normal values is 2.8 to 8). Mabuhay!!!
Mabuhay!!! Kamusta ka? My wife is Pinay..... there are several Pinoy here.... You sound like you've got things covered. In fact maybe you should post in "PROSTATE CANCER NETWORK"..... the group here is for men with mets.... It's up to you...
I always try my best to be informed. You know how financially draining to be treated here in Pinas. Some may not even have the money for consultation and just live with PC. If only we have a good medical insurance to support us we can survive this long. This site has been very helpful.
I could hook you up with a couple in the Pinnes who are fighting this disease, but I have to ask them first. They are both very nice and my wife and I met them about 2 years ago in the Pinnes. I understand the issue of medical care there....BTW I am a total badooie....
I am unclear about the duration of the ADT recommendation. Was under the impression that with low volume disease and low PSA levels six months ADT was sufficient.
Your stats sound very similar to what mine were. I had a robotic prostatectomy in February 2006, I was good for several years and when the cancer came back I had radiation for seven weeks. Then I was good up until several years ago in 2018 when my cancer came back again. Sometimes I never get all the cancer cells they hide and then produce and elevated PSA again.I then have the test a size in my lower pelvic area into 18 it was put on Lupron, Zytiga, and prednisone.
It eliminated the metastasis , And I have been cancer free for the past two years.
My suggestion is that you do the radiation as it helped me significantly.
I finished the radiation in August. Three months after radiation the PSA is 0.02. The oncologist said I have to receive ADT for 2-3 years. I accept Reseligo 10.8. I don't have any side effects. How are you?Adam
Hi Adam: I am unfamiliar with Reseligo, but as I mentioned in my previous message, I had different regime. At this point, I have been off all meds since July 2020 and am stabilized and cancer free! Just hope it stays that way…….all the best to you.
Hi Adam 1967,I've had a similiar journey to you. In September 2015 I had a radical prostatectomy. However further PSA tests showed that not all of the cancerous cells had been removed. Clearly some had escaped my prostate. My PSA was rising slowly but surely and by January 2019 it had reached 2.35 ng/ml. However my clinic was unable to locate the new location of the Cancer. In May 2019 I had a PSMA Gallium 64 scan in Heidelberg which located 5 locations in my pelvic lymph nodes (LHS). Subsequent to this I was placed on Casodex 50 mg for 1 month and then Decapeptyl 4.25 ml injection over a six month period. These brought down my PSA levels to 0.06 ng/ml after 3 months. In October 2019 I had a series of Radiotherapy treatment - 20 sessions with a total of 55 gray. This has now brought my PSA down to 0.01 ng/ml. I have had some side effects with weight gain due to the medication, some fatigue and some urine retention issues and a little proctitis, none of which were in any way debilitating. Now in February 2021 I have lost the weight gain and have very little issues with food, urine etc. I walk at least 5miles (8 km) per day up hill and down hill and my PSA is now 0.02 ng/ml. Yes Adam. Go for a sharply focused radiotherapy programme.
Hey Adam, sounds like you are doing all the right things. My lymph nodes were clear during the prostatectomy surgery. My 1st psa after surgery was 4.5 so I went to Dr Patrick Walsh at John's Hopkins who after examining my prostate determined that urologist left prostate behind. His recommendation was to have prostate bed radiated which did not help. I am on lupron 3 injections once every 3 months and oncologist doc gives me a break which on average is about 10 months. I pray that you continue to do well.
Hi, I recommend that you target the metastase, now my Psa is very very high 739 but the docter said the psa doesn not really matter in my case. Aftertraitements chimio, radio, radium 223 now I am a new traitement Luthecium 177 it’s a radio activ . The traitement comme from Israel it’s very expensive but it’s free for me. I feel very good now. Good luck to you.
I was born in 1967.The PSA in August 2020 is 10.75
I was diagnosed with cancer in September 2020. Prostatectomy and extended lymphadenectomy performed on December 8, 2020. in OLV Aalst Belgium, prof. ALEXANDER MOTTRIER.
Gleason score 7 (4 + 3).
pT3b pN1 pMX.
January 14, 2021 PSA 1.18
January 25, 2021 I received LHRH reseligo 10.8
February 1, 2021 PSMA PET SCAN
There is a left posterior obturator lymph node with increased tracer uptake (SUV max. 17,8; approx. 1,0 cm transversal diameter) anteriorly to the internal iliac vessels. A focal uptake of tracer is noted medially to the right psoas at the level of L5-S1 transition, where there is likely a small soft tissue oval structure (up to 0,5 cm in transversal diameter). There is focal uptake of tracer (SUV max. 11,6) in a small aortocaval lymph node (transversal diameter of 0,5 cm) at the level of L3-L4 transition; faint uptake can be noted in an additional small aortocaval lymph node (SUV max. 5,3; 0,4 cm in transversal diameter) approximately at the level of L2-L3 transition. There are no lesions with increased uptake of tracer in the skeleton and bone marrow.
CONCLUSION: There are no clear scintigraphic signs of residual disease/relapse in the prostatic bed; minimal uptake posterolaterally to the left behind the bladder neck? - ev. correlation with MRI. There are several metastatic lymph nodes noted: left posterior obturator lymph node anteriorly to the internal iliac vessels, right medial to the psoas muscle (level of L5-S1 transition), aortocaval (level of L3-L4 transition), likely another aortocaval lymph node (approx. level of L2-L3 transition). There are no scintigraphic signs of distal progression elsewhere
08.February 2021, PSA 0.53
I go to the oncologist again to see if he will recommend radiotherapy to me. What do you think if you do radiotherapy of the whole pelvis or target metastases? If you have tips for further treatment please help me. Thank you.
First of all, thank you for your prompt and detailed reply.
Next I am not an authority on Pca but know a little bit to converse with a nice looking woman at a cocktail party....
To answer your question I've seen Tall_Allen suggest that it is preferable to target the whole pelvis rather than just the mets. Tall_Allen really knows his shit.... you'll see...
Next you are just like all of us used to be "panicking"... slow down, catch your breath you will be around for many many years.
Born in 1967 makes you around 53 years old. (I've got dandruff older than you)....
Again learn here get a good MO and keep posting here. (and laugh)...
Alex Mottrier was the second name in my short list for preferred RP surgeons. I had got very strong references from a surgeon that, presumably, had followed his robotic training courses. He told me that he is very experienced in extended lymphadenectomy, a task only for the seasoned/talented surgeon. Consequently, I gather that your remaining lesions are not resectable. In case they are, you could have a look at PSMA guided salvage surgery at Hamburg (Martini Klinik) or Munchen (TUM). Good luck.
Usually, the lower your PSA the less likely lesions will show up on the more sensitive PET scans. Since your PSA is so low, the whole pelvic salvage treatment would probably be safer. It would clean up areas where there is nothing showing up on the scans at this time.
I had radical prostatectomy and lymphectomy as well as two years of ADT and radiation. However, my Gleason score was as high as 9 (Biopsy) and 10 (on surgically removed lymph node). The PSA was 13 four months prior to treatment (the PSA had doubled every 6 months before then). The surgeon couldn't feel the cancerous tumor (mine was soft) and did not think that I had cancer due to my age and good health until the PSA reached 12. I decided to go with all three treatments against the advice of the radiologist because of the spread and the aggressiveness of my cancer and the lousy prognosis. My ADT treatment started in February 2017, the same day as my clinical diagnosis, followed by surgery in April and radiation in spring 2018 (the bladder took time to heal).
My prognosis was 6 months without treatment and expected relapse after 16 to 20 months (median). Fortunately the treatment worked better as expected and my PSA test was still negative 3 months ago. The downside is living with the negative impact from the aggressive treatments, such as lack of bladder control, stiffness, high blood pressure (water collection), bone and muscle pain, sleep disorder, impotence and some other minor inconveniences. Yet I am still alive and thus very happy.
My dear ones, I finished radio therapy on August 8th. On March 23, 2021, SBRT was performed on both aortic cocaine lymph nodes. I received TD 20 Gy (at 80% isodose), once, by arc technique (RapidArc) with furniture with kV-CBCT and intafraction monitoring with OSMS-on. In the period from 16 June to 9 August 2021, salvage radiotherapy was performed on an outpatient basis. The patient received TD 46 Gy on pelvic lymph nodes, TD 64 Gy on FCH positive lymph nodes, and TD 70 Gy on the back of the prostate in a total of 35 fractions by VMAT technique with daily imaging (IGRT) with kV-CBCT. the oncologist told me that ADT I have to be 2-3 years old. 2 months after radiotherapy PSA is 0.02, testosterone 0.596. I ask dear friends to give advice on what to do next?
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Explain my PSMA PET SCAN Please..
PSMA scan results 
Fosfestrol ( oral Estrogen )/ Honvan for mCRPC progression ? 
PSMA PET Scan Shows no mets?!
