PSA Rising After RP, Radiation, ADT &... - Advanced Prostate...

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PSA Rising After RP, Radiation, ADT & Clinical Trial

Jlgjdf profile image
8 Replies

My 69 year old husband was diagnosed in 2014 (PSA 12.7, Gleason 4 + 3). After RP (Dr. Peter Carroll), ADT, radiation (Dr. Albert Chang) and UCSF Androgen Annihilation clinical trial (Apalutamide + Abiraterone + Prednisone in addition to ADT, his PSA was non-detectable for 1 year. Now it is on the rise again - doubling every 2 months. It's now at .25. Dr. Aggarwal has advised waiting until it hits .5 (estimated to be later this summer) to do a PSMA scan. He had one a few years ago that was negative. After the PSMA, and depending on what's found, Dr. Aggarwal will recommend radiation ( if possible) and/or back on ADT.

Question: Once we have the PSMA results, should we seek a 2nd opinion or just follow Dr. Aggarwal's advice? If so, who should we see? Are we missing anything?

As I'm sure everyone appreciates, this has been a difficult, life-changing journey that has robbed him/us of many of the things we previously enjoyed in our active lifestyle. Like everyone, we're hoping to manage this and maintain some quality of life. Thank you in advance for all of your intelligent and compassionate feedback, information and resources. I really appreciate this forum!

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Jlgjdf
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8 Replies

I started a yr after your husband did . I’ve been clear myself .. always knowing that the nature of APC is to re-occur ? I’m in Az and even I have heard of Dr Carroll . I think that UCSF is top notch . Any rise calls us to alarm . But his Psa is still low .. He has a sound partner in you . My wife ‘s love has kept me here also . How does he feel . How’s his QOL? Peace to both in decisions to come . 🙏

Jlgjdf profile image
Jlgjdf in reply to

Thanks for your response. I appreciate the reassurance. Right now QOL is good except for the dark cloud that is always there wondering what’s next. Hopefully he’ll tolerate the next round of treatment and be able to keep up a decent QOL. Best wishes to you on your journey.

in reply to Jlgjdf

One step at a time. Day by day . Take care

GP24 profile image
GP24

I had a PSMA scan done at 0.5, one at 2.0 and one at 3.0. Finally the scan at 3.0 ng/ml showed small lesions. Therefore I would wait for the PSA value to get above 2.0 to avoid another negative PSMA scan. I think Dr. Aggarwal assumes you do not want to wait that long and therefore recommends a value of 0.5. It could turn out to be a waste of money. I see no reason not to wait for the PSA value to get above 2.0, except patient anxiety. Salvage radiation was already done, so you do not have to observe a value of 0.5 ng/ml any more.

Tall_Allen profile image
Tall_Allen

I doubt you will find any better than Rahul Aggarwal.

Jlgjdf profile image
Jlgjdf in reply to Tall_Allen

Thank you for your comment. I really appreciate your feedback and insight. It sounds like there’s nothing else to do but what we’re doing.

timotur profile image
timotur

It appears your husband is becoming castration resistant to ADT if he is still on Abi or Lupron, and there is metastasis to either LNs or bone indicated by the rising PSA-- more likely to the bone, if salvage radiation treated the pelvic LN's successfully. If so, I would want to know that sooner than later, and go ahead and get a PSMA scan at PSA 0.5, which I think remember has about a 50% sensitivity rate at that level. If indeed, bone mets are found, that would probably indicate chemo as the next step, and/or SBRT to mets in a oligometastatic setting. You may also check ALP to see if there is an upward trend which would indicate bone activity in response to mets. My MO is recommending no scans until 0.7.

Savoy profile image
Savoy

Wow, that’s pretty good. My doc won’t explore any other options until im up to 5

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