Waiting for PSA

[Jvaughan0]

It has been two and a half months since my PSA became detectable again after a four year break. (Gland removal in 2014, radiation and Lupron in 2017) PSA was .2 in April, .2 in May and .3 now in June. My MO says let it go above .5 so a scan may better locate the cells. He advises starting ADT now will put the tiger back to sleep before it can be found. Still I wonder if we are talking controllable kitty or runaway train by waiting.

[Tall_Allen]

I agree with you. I'm unsure that detecting and SBRT-treating recurrent metastases has any benefit, but clinical trials like the ones below suggest that treatment intensification before metastases are detectable may improve outcomes:

meetinglibrary.asco.org/rec...

meetinglibrary.asco.org/rec...

[garyi in reply to Tall_Allen]

Along the same line, Allen, I was recently told by a young and seemingly sharp urologist that any persistent PSA that continues after both RP and SRT is "serious" and should be regularly treated with ADT as a matter of course. I'm still waiting from her for any citations or studies on the matter. I couldn't locate any.

Have you noted any new concerns about continued persistent PSA after both surgery and radiation?? Thanks.

[Tall_Allen in reply to garyi]

I think the treatments for recurrent and persistent are similar. I'm looking forward to the clinical trial that combines Erleada and Zytiga:

clinicaltrials.gov/ct2/show...

There seems to be a consistent sign of benefit from early intensive treatment.

[Channelhomec in reply to garyi]

At what psa is considered persistent psa > Ihad a psa of >0.06 >for 5 yrs and I was told it was undetectable eventually needed salvage think I should of had salvage 5 years go trusted the doctor

[Hidden in reply to Tall_Allen]

In all of these years...has there been clinical trials that included chemo combined with anything for BCR men?

[Tall_Allen in reply to Hidden]

Yes.In fact, two major Phase 3 randomized clinical trials have proved that there is no benefit in adding docetaxel to ADT in BCR men:

euoncology.europeanurology....

jamanetwork.com/journals/ja...

[garyi]

Very interesting clinical trial.

[Timmer1967]

My situation is very similar to yours. My urologist is Matthew Tollefson at Mayo Clinic. He is suggesting that I wait till PSA gets to .5 and then have a scan to try and locate the tumor(s). Last PSA was .24 two months ago. My next PSA check will be in August. I had G9, prostatectomy in2018, then 15 months later, salvage radiation and 6 months lupron. I have been wondering if waiting is the best approach but my Dr has been fairly reassuring regarding this. Thanks for your posts and best of luck.

[Jvaughan0 in reply to Timmer1967]

Our situations do seem to parallel. I have had only one consultation with an MO -- one who I researched and decided to have confidence in. Unfortunately, I don't think following any expert suggestion is easy for me; I am always skeptical. I need time to take the measure of the person before I can value their expertise. I haven't reached that level with this doctor. My best to you as well.

[Hidden in reply to Timmer1967]

I'm similar to you also...pT3bN1M0 after RP in June 2019 12 nodes removed with 1 positive. Started 2 years ADT immediately after the post RP psa was not undetectable. I followed the ADT 2.5 mo later with 39 IMRT sessions.

Why only 6 months of ADT for you,?The SOCis 2-3 years of ADT for high risk pca...what was your original PSA at diagnosis?

[Timmer1967 in reply to Hidden]

At diagnosis, PSA was 18. I had 17 lymph nodes removed and 4 were positive. I have always wondered about why just 6 months of Lupron. Lupron gave me significant side effects so it was a relief to not deal with it for a longer period of time. I will push for using estradiol patches or gel if I have to resume adt.

[Hidden in reply to Timmer1967]

My psa was 12.3 at diagnosis and I'm coming up on my last eligard injection and stopping zytiga...im nervous and excited at the same time. I've been <0.1 for 18 months and probably <0.01 because that was the result of a ultrasensitive psa test last October.

[Jvaughan0 in reply to Hidden]

That sounds great. It is all about finding grace - celebrating the good moments and accepting the bad.

[Hidden in reply to Jvaughan0]

I think the best this site has to offer are fellow pca experiences...go heavy up front, for me that was RP, ADT +Zytiga and IMRT.

[tetech]

One of my fellow PCA survivors at the cdmrp.mil conference said that he had salvage re-radiation of his prostate bed; this time with protons. He didn't have any side effects and it got rid of the PSA.

[Blackpatch]

If your PSA is >0.1 then you really have no reason to wait for a PSMA scan - if you can't image something with PSMA at that PSA level, that in itself is a useful piece of data. I understand these scans aren't yet widely available in the US, but the practice in Australia seems to be to do a PSMA scan on recurrence and see what there is to see - anything that will be visible at 0.5 will also be seen at 0.2, and almost certainly at 0.1.

[Jvaughan0 in reply to Blackpatch]

No matter how advanced science becomes, it will always be constrained by the society in which it exists. It will never be readily available or afford to all those who seek it. Knowledge is power when wealth allows it to be. Man... that was a string of truisms. I wanted a scan in April, but I was told to travel across the country (maybe) or wait until my PSA increases. Hmmm... And I didn't even knock on the door of my Medicare Advantage provider because the bar was already set too high.

[RonnyBaby]

I had a BCR after an ADT vacation - about 8 months ago. It was suggested that I WAIT / hold off ADT until I could get a PSMA scan (PSA was doubling every 3 months).

Any form of ADT type intervention will 'MASK' the cancer cells and give you 'inaccurate' numbers.

It is highly likely that you would resume some form of treatment after the scan(s) are completed, but in order to get a better 'picture' of what / where the cells are located, you'll need to wait to get a better assessment.

My PSA rose to over 11.0. I've resumed my chosen form of ADT - monotherapy.

3 months later my PSA has dropped to 0.48 and I'll be retested in 2 weeks - expecting it to be even lower.

This isn't a race to the finish line - there is time to consider the options and advantages of the decisions that could be made.

Wishing you the best on your journey .....

[MateoBeach]

I agree with Blackpatch. Despite conventional wisdom about PSA needing to be >0.5 for PSMA PET scans to be sensitive enough, it would probably provide you with useful information now. UCLA has a cutoff of 0.2 for Ga-PSMA scans. And the newly FDA approved DCFPyL PET scans are even more sensitive. I had one last week at the LA VA Hospital with my PSA at 0.07. It lit up brilliantly my 2 previously irradiated pelvic nodes, and also disclosed a new one, previously unseen just 0.5 cm in diameter. So I would suggest getting a PSMA scan now and proceeding directly to whatever treatment is indicated, rather than waiting. Paul

[Jvaughan0 in reply to MateoBeach]

Conventional wisdom is generally a dogmatic request to conform to social norms. It may not be the preferred option, but sometimes waiting is all we have. Still, I appreciate your suggestions. Fighting prostate cancer is certainly a war with many fronts.

[MateoBeach]

Indeed! I meant conventional wisdom as commonly accepted assumptions. But like your definition better! Keep on. 💪💪💪👍🏼👍🏼