6 weeks post RP and removal of lymph glands with one positive, the PSA was 8.4 and Testosterone 15. I hesitated on starting Lupron and discussed with both the Oncologist and the Urology surgeon whether surgical castration would be appropriate. The decision was that I would wait for another PSA/Test bloodwork and that came back at PSA 3.9 and Testosterone 12.2. I have an appointment with the Oncologist on Thursday and I've started Bicalutamide 50m orally and will be having Lupron injection in 3 days and henceforth every 4 months.
I'm waiting for a PET/CT scan, likely in the next month and I'm still feeling fine and working full time. I listened to the advice from this great site and hopefully things will continue to be stable.
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Hailwood
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That hasn't been mentioned to me yet as an MRI of the pelvis showed no lesions and a contrast bone scan showed no mets in the skeletal system. Should radiation be considered if there is no ability to focus on any lesion?
Yes. Persistent PSA is a sure indication that salvage RT is needed. Your PSA dictates that adjuvant ADT and whole pelvic RT must be used. Imaging is only used to rule OUT salvage RT. That is, if, say, bone metastases were found on a bone scan, pelvic radiation would be futile and lifelong ADT would begin. You have to treat what you can't see.
I think in your case a PSMA PET/CT or, if that is not affordable, an Axumin PET/CT should be done to locate the reason for the PSA value. Then you can plan the radiation of these lesions.
Yes, I agree with the others that a PMSA should be done - more sensitive than Axumin but ins co may not pay. You MUST have cells somewhere for the PSA to still be that high and hopefully they are in the prostate bed where radiation can kill them. You should probably be on hormones anyway to make the cells more radiosensitive and easier to kill...Get it now and you will be OK! Best of luck! AL
I'm on the list for the PSMA PET/CT scan. The high number is a little worrying though and we'll see how it looks at the next PSA. Thanks so much for all your help guys. Its a long road and its very supportive to have a team around to advise/cajole. Merci beaucoup
I looked at it but don't know enough of the answers to its questions about your disease to use it.
If I remember correctly, it used to be said that salvage radiation was most effective if given when the PSA after failed surgery was <= 0.2 ng/dl and the odds of success gradually declined after that until PSA reached around 2.0, after which the odds of success were very low, though there can be special circumstances where it might still work. Since radiation is not side effect free and since, if no focal points for the cancer can be identified, it must be given over a wider area, it would be pretty disappointing to undergo radiation and its side effects only to learn that your situation was not improved.
Most men don't like the side effects of Lupron. They begin about two weeks after the injection. They include loss, very likely total loss, of libido, reduction of strength and energy levels, and hot flushes. In my case the hot flushes were one or two minutes long about once per hour. The sexual side effects can be overcome by, well, determination. You try to satisfy your wife or partner and, when she is really aroused, you get aroused too . The energy side effects can't be fully overcome but can be greatly mitigated by determined exercise. The hot flushes can be overcome by ignoring them, keeping a fan nearby, or if they persist for a very long time, by medication.
Lupron will change your testosterone and PSA test numbers. If you are planning to get new testing (PET/CT or whatever) ask if the results are useful when the tests are given to a man in early stages of ADT and, if not, see if you can get the tests before starting Lupron. Ask about the bicalutamide too.
Lupron does work. It used to be thought that it was purely palliative and should only be used once cancer symptoms appeared but, as I understand it, trials have shown that it can extend life, and extend it more when given earlier in the cancer process. Life won't be exactly the same with Lupron but, at age 65, you've probably already learned that life changes as we grow older even without Lupron. I believe that life, with or without Lupron, can still be very, very good.
Thanks so much. My appointment for the PET/CT scan is being hurried through and we will hold off on treatment until the next PSA on April 1st to see if it still falls further, Its a very salient point about the salvage RT with a more elevated PSA and that was the thoughts of my Oncologist. If the scan reveals lesions that can have focused beam radiation it will be in addition to Bicalutamide/Lupron, and if none are visible and the PSA is below 2 then salvage RT and the meds will start.Thanks for the advice re the side effects. I'm happy with the plan and this disease had led me to be as calm as possible and to go with the flow metaphorically speaking.
Hi Hailwood. I was undetectable until 1 year after RP. Salvage Radiation at MSK in Harrison NY with Dr Mahalchyck Some minor side effects feeling(tired and minor leakage I also had 6 months of Lupron but well worth it !! I agree with TA. get it done ASAP.
After my RP , and removal of 27 lymph nodes, I ended up dealing with Lymphedema related swelling of my left leg. Needed physical therapy and a leg wrap to control it.
Just writing in support of what Tall Allen wrote. Your only good choice for the best outcome is salvage RT to the prostate bed and full extended pelvic lymph node fields with one to two years of ADT. It does not matter what the PSA does now. Only if PET CT shows cancer activity outside of the pelvis would make that futile. Hoping for the best for you.
I see you're in Canada ehh? I use Mayo clinic, at the time in MN now in Phx, and I swear by the Choline C-ll Pet scan there. I hear the PSMA is more sensative but the C11 is covered by insurance and also very sensative. It pinpointed lesions on my spine and ribs which we then zapped with Cryoablasion, twice. That was 5/6 years ago and here I sit.
I also had high PSA, 50, RP, and removal of some 25 lymphs 1 of which was positive, the peri-prostatic. We bypassed radiation in lieu of chemo.
I started in 2011 and now on Lupron, Xtandi, Xgeva and living a fairly decent quality of life.
As far as my boys, those go with me in the ground, not even up for discussion.
I’m on the treatment advised in the Latitude trial. Lupron, Zytiga and prednisone. My post surgery PSA rose to 3.6 and a PSMA last October showed three small spots on lymph nodes and one spot on my hip. Started the Lupron this last November, Zytiga lastJanuary and thanks to the ADT I’m now currently undetectable. Still possible radiation in a few months to the hip met. Good luck!
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