Additional PC treatment

[lhall2]

I had RP nearly a year ago at 73 years of age with the prostate and 10 lymph nodes removed. One lymph node was found to contain PC. My Gleason score was 4+3=7. I switched to ultra sensitive PSA for may last two test. Results were 0.028 and the latest 0.026. As I understand with the prostate removed my PSA should be 0.000. I also understand a detectable minute PSA could result from 1. Some minute PSA tissue remaining after surgery ( I fell good about my surgeon as he has performed over 10000+ RP) or 2. Some minute PC cells remaining. While it is a good thing my PSA is at a such low level and constant, I don’t want to play “ Russian Roulette” with cancer, so I have elected to start 40 sessions of radiation and lupron injections. My urination has returned to no leakage so that should help with radiation side effects. Any thoughts please

[Tall_Allen]

Good decision! The deciding factor is the positive lymph node. Where there is one, there are probably dozens more that haven't been investigated. Lymph is a slow-moving fluid that carries can cer cells throughout the prostate drainage area (which has recently been widened to include the common iliacs). Whole pelvic radiation with 2-3 years of adjuvant hormone therapy is your last chance at a cure.

[GP24]

The guidelines state you should start with salvage radiation when the PSA value gets above 0.2 ng/ml and while it is below 0.5 ng/ml. You can start earlier but I personally would not start at 0.0 ng/ml as you currently have. I would get just six months of ADT following radiation. Your RO probably suggests no ADT at all.

[Tall_Allen in reply to GP24]

That is definitely not what any US guidelines state for lymph node positive PC.

[Gemlin_]

Discuss timing of treatment carefully with RO experts. Could be over treatment in your case. Without the high-risk factors (pT3, Gleason 5, >1 positive nodes, PSM) patients could wait until they developed biochemical recurrence, IMO.

[lhall2 in reply to Gemlin_]

Thanks for the feedback. However as I stated earlier my Gleason rating was 4+3=7 so an indication of more aggressive PC but lucky with only 1 positive node. Hard call to make

[Justfor_]

The most important metric related to progression is the rate of rise of PSA. With only two tests at the sensitivity border of the test, you don't have any, even a very distant idea of what the latter may be. If you feel comfortable for going foreward with such an ultra early sRT, by no means go for it. BUT, do not fool yourself believing you have any tangible information originating from 0.02x.

[lhall2 in reply to Justfor_]

Thanks for the feedback. I probably would not be doing anything & feel good about a PSA of 0.02x if that was all I had to go on. But it is the combination of that result plus the Gleason score of 4+3=7 indicating a more aggressive PC and the positive 1 node result. Hard call to make

[Blackpatch in reply to lhall2]

You could have Decipher analysis run on the pathology specimens from your RP - that would give you a clearer indication of just how aggressive the cancer was and how aggressively you need to treat it.

[marlins1]

Do the salvage+ADT, you got a positive LN. There are more and this is your last best chance for cure. Hope that it is locally contained.

[Hailwood]

Apart from the age difference, I'm 65, we sound very similar. Gleason score 4 +4. After RP, with PC found in the left lymph nodes, the first PSA (6 weeks post surgery) showed a level of 8.4 and it was recommended that I start Lupron. I have mulled this over and discussed the option of surgical castration as opposed to the chemical, but both the surgeon and the oncologist feel because of the high number that I should commence Lupron as well as a PET scan in the near future. Recent bone scan showed no mets in any of the skeletal system and a repeat PSA is happening on Monday. Because of the lack of mets in either the bones or in soft tissue in the pelvis (confirmed by contrast MRI 2 weeks ago), I'm not looking at any pelvic radiation right now.

Hopefully your course of treatment keeps your PSA at a low level. Good luck with your treatments