Bioquimical recurrence after PRP, rescue radiation and now?

[anpun]

Hello

I'm new in this forum. I’m 53 years old. I’m from Spain.

PCa gleason 4+3. T2N1MO (1 lymphatic node of 28). Prostatectomy (Da Vinci) in february 2017. Recurrence in December 2019 (psa:0.21 ng/ml).

PET/PSMA show the prostate bed and one lymph node were illuminated.

28 session of radiation was given (august 2020) to the prostate area (61 Gy) and the dose increased (63 Gy) to the PSMA uptake area. To the pelvic area (50 Gy) and 62 Gy to the uptake area.

ADT 6 moths.(Casodex+Decapeptyl)

16/09/2020: psa: 0.02 ng/ml (T=21).

04/01/2021: psa:0.02 ng/ml.(T=456).

05/07/2021:Today psa: 0.16 ng/ml (T=508).

I have a consultation with the Ro the next wednesday. What are the next steps to follow?

Thank you very much.

[GP24]

If you follow the European prostate cancer guideline you should do nothing now and just observe the PSA value. It is recommended not to "treat" the PSA value with hormone therapy. You can wait till the PSA value rises to 3.0 ng/ml and then get another PSMA PET/CT to see the reason for the rise and plan the treatment then.

[Tall_Allen]

If the very rapid PSA velocity continues, continue starting on ADT again.

[GP24]

If you stopped taking Casodex+Decapeptyl and your testosterone has recovered, no wonder your PSA value has risen. There are probably small metastases too small to be detected. All you should do is observe the PSA value and eat some fish at El Serrallo while doing that.

[anpun in reply to GP24]

Could it be that cancer cells die slowly and psa is falling?.

If not, are there no longer any chances of a cure?

[GP24 in reply to anpun]

As you had an affected lymph node, I think the chances of cure are very small. However, I think you will live with your prostate cancer for a very long time. My estimate is 15 to 25 years. The chances are higher that you die from a heart attack or a stroke than from this prostate cancer which does not seem to be very aggressive.

[Hidden in reply to GP24]

Correctomundo! The heart can get us .

[Hidden in reply to anpun]

Dear anpun . Hope springs eternal . Never give up or we are done. Once metastatic there is no cure. This doesn’t mean miracles don’t exist and some men live for decades past dx. It’s no cake walk . You know that . This is a f d up disease for us fine fellows and those that love us . Hang in there 💪

[Hidden]

Welcome young man. I too was 53 upon gl8 #4 dx. I did imrt and double adt . Kept resolve and push that pc down again until it first get back up . You suffered so much already . You need a break man 🙏

[Clhammy]

Hey Anpun, I was also 4-3 Gleeson. I had 3 bone scans and ct scans with no signs. After my prostectomy my psa was 4. Something, this was when I had my focal radiation to the prostate bed. Well the first psa test after radiation my counts were elevated. I believe I was given the wrong advice from my radiologist oncologist first said that wait until counts get to 10 and then start the injection of lupron, well 10 went to 20 then 30 and by the time I started lupron I was just over 100. My new oncologist recommended a bone scan and CT scan, and the results were negative. I have been on lupron ever since. I do 1 dose every 3 months for 9 months and off for approximately 1 yr. I have just past six months with no shots but still feeling side effects. My doctor says that when my counts rise again he plans to do a different type of scan that actually lites up microscopic signs of the cancer. I hope my rambling helps but this is where I am. I started this journey when I was 54 and I am going to be 65 next month. God bless you, Tom

[anpun in reply to Clhammy]

thanks for your advice. What type of side effects do you have?

[Fanger1]

Anpun,You may consider asking your doctor to test your blood for Circulating Tumor Cells as it good to get a baseline before starting new treatment. After treatment begins you can do repeat testing over time. Good luck with the next leg of your journey🤙

[anpun in reply to Fanger1]

I do not understand what would contribute.

Thank you Fanger1

[Fanger1]

CTC are found in serum of some cancer patients and today there's several companies that have blood tests for them. The technology is getting better all the time. It is another biomarker to detect residual molecular disease not only in finding the number of CTC (enumeration) in ones circulation, they check for abnormalities on the cancer cells surface. I've been getting this type of testing after my RP from Biocept in San Diego California. Researchers in Spain most likely have another test available like this. Up to date medical oncologists should know of this technology. Please read about it in the literature, good luck with your treatment🖖

[anpun in reply to Fanger1]

Hello

On Wednesday I have a visit with my MO and I would like to know what important questions I should ask him. Can you advise me? And there is something that I am not clear about. It is always better to start with ADT or you can be more aggressive and go to chemo straight away. Thanks

[anpun in reply to anpun]

I visited MO in July and he said let's wait 6 months to see the next PSA. 6 months are completed in January, but in the review of the work that I did last week gave me a psa of 0.38. In January I imagine it will have increased and MO will tell me what to do. I understand that ADT should start. Which?. Could I do a PSMA Ga68 and see if I locate the focus, although what use would it be if it seems to be systemic? Advise me please

[Justfor_ in reply to anpun]

Your PSA doubling time is less than 4.5 months. Aggressive type. A new PET scan read against the initial one will provide a more comprehensive means of assessing progression than the PSA trend alone. The doctor that put you on a six months hold after the sRT failure will surely won't/can't make use of such advanced piece of information. To start with, you need to find someone that can.

[anpun in reply to Justfor_]

I shade the novelty:

PCa gleason 4+3. T2N1MO (1 lymphatic node of 28). Prostatectomy (Da Vinci) in february 2017. Recurrence in December 2019 (psa:0.21 ng/ml).

PET/PSMA show the prostate bed and one lymph node were illuminated.

28 session of radiation was given (august 2020) to the prostate area (61 Gy) and the dose increased (63 Gy) to the PSMA uptake area. To the pelvic area (50 Gy) and 62 Gy to the uptake area.

ADT 6 moths.(Casodex+Decapeptyl)

16/09/2020: psa: 0.02 ng/ml (T=21).

04/01/2021: psa:0.02 ng/ml.(T=456).

05/07/2021:Today psa: 0.16 ng/ml (T=508).

11/01/2022: psa: 0.51 ng/ml

I have a consultation with the RO the next wednesday. What are the next steps to follow?. I would like to discuss with him the best way to proceed

[Justfor_]

What I wrote two months ago still reflects my position and even strengthens it as your PSADT shrunk and is currently less than 4 months. What you will probably hear is that there is nothing to do right now but wait until a PSA "magic" number is breached when you will start systemic treatment. "Magic" numbers vary from doctor to doctor but all share a common feature, are integers so easy to memorize. All of the following have been around: 1, 2, 4, 5 and 10.

[anpun]

Should I wait?

[anpun]

My MO visited me today and ordered me to do a FL-PSMA. It is the same as a PSMA Ga68?. Are they just as sensitive?

[Justfor_ in reply to anpun]

In general, yes, they are regarded as equal. Some even claim that the Fluorine18 labeled is a bit more sensitive. There is an important footnote though. There is a number of Fluorine18 labeled radio pharmaceuticals that are excreted from the body by two different tracks. The one approved in the USA, under the trade name Pylarify, follows the same route, via the urinary track, like Ga68. In contrast, F18 PSMA 1007, approved in a number of European countries, is excreted via the liver providing better visibility into the prostate (for those who still have the gland) and the bladder. In my personal opinion the later is preferable as it is not unusual the post RP recurrence to be at the bladder neck or close by. With Ga68/Pylarify this part of the body is masked by the radio ligand within the bladder. You should ask which F18 labeled radio ligand is used in your country.

[anpun]

Thank you very much

[Justfor_ in reply to anpun]

I am glad that they didn't put you on hold and are trying to find the source of your recurrence. If your PSMA pet shows any lymph nodes suspiciously lighting up there is this Ferrotran Nano-MRI in The Netherlands that is even more sensitive. Since you are in Spain it is not far away from you, but it is expensive ~4k Euros.

ferrotran.com/why-ferrotran/

[anpun]

History:

PCa, gleason 4+3. T2N1MO (1 lymphatic node of 28). Prostatectomy (Da Vinci) in february 2017. Recurrence in December 2019 (psa:0.21 ng/ml).

PET/PSMA GA68 show the prostate bed and one lymph node were illuminated.

28 session of radiation was given (august 2020) to the prostate area (61 Gy) and the dose increased (63 Gy) to the PSMA uptake area. To the pelvic area (50 Gy) and 62 Gy to the uptake area.

ADT 6 moths.(Casodex+Decapeptyl)

16/09/2020: psa: 0.02 ng/ml (T=21 ng/dl).

04/01/2021: psa:0.02 ng/ml.(T=456).

05/07/2021:Today psa: 0.16 ng/ml (T=508).

11/01/2022: psa: 0.51 ng/ml (T=385)

08/02/2022: PET F18-PSMA: Conclusion: showing no signs morpho-metabolic effects of locoregional or distant tumor recurrence.

I don't know what my MO will recommend if I wait or start treatment. What do you think? What treatment do you think I should start?

[anpun]

Some advice please?