Rising PSA despite salvage radiotherapy.

[HKKWL]

I have posted before but may be a short introduction helps. I am 71 yo and was dx of Gleason 6 back in May 2019 with PSA 10.5. Had my RARP in Toronto (Princess Margaret Hospital) in Oct 2019. I did not have lymph node exploration because the urologist did not feel that I needed it with Gleason 6. Pathology report came back with Gleason 7(3+4), but with extracapsular extension and positive surgical margin. Recovery was rough with several episode of urinary retention, but eventually settled down. Regained most of my continence back within 10-12 months. Tracking PSA every 3 months was not so favourable. Started with 0.026 to 0.032 to 0.040, at which time I was referred to a radio-oncologist. I went through salvage IMRT in Oct 2020 of the prostate bed. But there was no reduction of PSA whatsoever. They came back to be 0.033(Oct2020), 0.040(Jan2021), 0.045(Apr2021) and now 0.061(Jul2021). During all the while, I went through about four UTI's whereas I never had one before.

I will be talking with my radio-oncologist in 2 weeks. I wonder if it is too premature to seek testing for mets. Not sure how I should be interpreting this persistent rise in PSA despite treatment? What questions should I be asking the radio-oncologist? I am not scheduled to see my urologist(specialized in PCa) until Oct2021.

I believe it is a matter of time to start ADT. What can I do for now?

Please advise.

[Hidden]

So I am in a similar boat, except that i had lupron for 7 months at the same time as the early salvage radiation. I just became detectable at 0.07 after about a year after my last lurpon shot. So basically now its a waiting game. Every MO i spoke to said that until I reach 0.2 there is not much they recommend, and even then they are saying to reach 0.5 before there is a chance a PSMA PET will point out the culprit. Some guys on this forum have gone to the Netherlands for a different kind of scan looking for mets in the lymph nodes using a technology called combidex nano mri. Apparently that can pick up a hot lymph node with a psa as small as 0.1. if they can identify an infected node without any bone mets then its like 24 months of hormones and full pelvic radiation for a chance to finally put the beast down.

[HKKWL in reply to Hidden]

Thank you for your recommendation. For now I'll try to get all the help I can in Canada first. May be I'm really too impatient. Or may be I'm unrealistic as to expect full recovery. I believe my faith in God is lacking.

[Tall_Allen]

I think your best strategy is to see if PSA continues to rise in October. For PSA below 0.2 and a slow increase like yours, there are no PET scans that are likely to show anything. You can start on hormone therapy or delay it, depending on your anxiety. Which kind of hormone therapy - iADT? bicalutamide? ADT? ADT+second-line HT? is all a judgment call. Perhaps a Decipher test might sway you in one direction or another.

[HKKWL in reply to Tall_Allen]

Thx Tall_Allen, your opinion is always respected. What is "i"ADT?

[Tall_Allen in reply to HKKWL]

intermittent

[Hidden]

Intermittent ADT?

[cesces]

If you want to do a one and done pet scan with the least likelihood of a false negative, you need to wait until your PSA reaches 2.0.