PSA results. Does this mean anything?

[inhaleexhalerepeat]

My dad is post ,RP May 2021, tumor stage T3a, N0. positive surgical margins, bladder neck invasion, perineural invasion. His PSA never went undetectable, lowest reading Aug 0.4. Subsequent readings are 9/1/21 0.437, Oct 0.6, 11/10/21 0.723, 12/22/21 0.819 1/26/21 0.85, Plan to repeat PSMA in Feb/Mar. He has been reluctant to start any additional treatment with ADT/salvage radiation. It seems that the rate of PSA increase has slowed down. Does this mean anything?

[Magnus1964]

I would go on casodex and see how he responds. If/when his PSA goes up go for the radiation.

[Tall_Allen]

No, it doesn't mean anything. He should get a PSMA PET scan immediately to rule out distant metastases. If negative, he should begin salvage radiation +ADT while it is still potentially curable. Perhaps you can help him overcome his dangerous avoidant behavior.

[Hidden]

After RP, PSA should be 0.

PSA means prostate cancer somewhere. Salvage radiation is generally done in the prostate bed when the PSA values are too low to get detection on imaging. With his PSA at .85, imaging might show something.

In any case, the best time to do salvage radiation is early on before the PSA really starts taking off. It's more effective if done sooner rather than later.

Something for him to think about.

[dd1953]

The quoted September measurement is an outlier and is likely to be in error. I suspect that the correct value is 0.437 and not 4.37.

In any event, an essentially zero reading was never achieved following prostatectomy and indeed the measurements are increasing. Your father would be well advised to take active and immediate steps as Tall_Allen and gregg57 have proposed.

[inhaleexhalerepeat in reply to dd1953]

Thank you. You are correct.

[TJGuy]

Action is needed,

It appears to me the time of active survillance was excessive and action should have been taken much earlier. That's water under the bridge now.

This is what I would do if it were me.

First obtain a definitive PSMA scan, Choline scan, or Axumin scan, PSMA if possible. MRI help with clear pictures of pelvic as well.

Second AFTER good scan, if still incontinent, go on short time Casodex until continence returns by performing Kegels if possible.

Once satified with continence, start Lupron, etc for several months before beginning radiation. Continue ADT for two years or as directed.

How has his recovery from RP been, incontinence is very often a result of RP. You want to give time to recover continence before beginning radiation.

Now one thing to remember is Lupron or drugs that prevent the production of testosterone weaken all muscles including your pelvic muscles which we rely on after RP for continence.

It took me seven full months of diligent strategic nightly kegels to go dry after RP beginning from ten pads a day on day one. It was a lot of effort.

I can only speak of Lupron, while on it I have some degree of incontinence, when off it I'm mostly dry unless drinking alcohol. Of course there can be some stress incontinence from exertion etc.

I'm guessing here in thinking Casodex may not have the save effect on incontinence as it works to only block the Androgen Receptor (AR) on the cancer from using testosterone. It doesn't decrease testosterone so you'll still have strength in your muscles.

So what I'm suggesting is short term use of Casodex as needed to get clear picture of if continence has returned. Then go on Lupron etc for several months prior to radiation and continue right through radiation for two years as directed.

You would need to first get the imaging with PSMA, scan(s) as you won't see anything from these scans once Casodex or ADT reduces PSA scores.

You may very well need full pelvic radiation and the imaging can tell you that.

My MAYO doctor says PC escapes from the prostate and then anchors itself right away and must grow significantly before it can spread new seeds of cancer. So even if you need your PSA to rise into the low single numbers to obtain an accurate scan this should not promote spread.

I am not a doctor, these are just my thoughts as I've been down this path already.

Good luck with your decision.

[Hailwood]

I totally agree with TA in that you need to see whether there are distant mets which will then determine treatment and if there aren't then salvage radiation and ADT will be the way to go

[j-o-h-n]

Now take a deep deep breath inand listen to our house experts. Tell your Dad if he doesn't listen to our advice we will send " "Dog the Bounty Hunter" out there to find out why not,

Now breath out.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 02/01/2022 8:05 PM EST -Today Chinese New Year of the Tiger.