In early 2013, I had 28 doses of PBT radiation at the Korean National Cancer Centre. I most impressive facility that gave me a great outcome. PSA was negligible until 3 years back. Last year my PSA was 0.34. A year later (July 22) it came in at 0.75.
The question is where do I go from here.
I should know having written three books on the subject, but would appreciate knowledgeable input.
Interesting that your (almost) identical post from a year ago is displayed on the side. Makes me sad that the main responder, Patrick Turner, is gone now.
TA offered advice back then which you have probably reread and that may still be valid. Not sure if your PSA is high enough to show anything on a PSMA scan as Patrick suggested.
Hi Alan. Sorry to read this. Likewise with Grumpyswife, TA offered some good advice last year but I do get that every increase creates massive stress. I was also sad to read some of Patrick's replies. So many good, decent men being taken too soon.
All I would add is that I looked at my copy of your 3rd edition book a few weeks ago. I had book marked one page, page 142 and put an asterisk by J591 when I read it in 2021. No other bookmarks. Matteo is the man who has pioneered, lead the way on this.
Good luck Alan
Seems like you now need to move on to a global therapy.
It's not clear to me what the benefits of doing any scans would be.
Will they really inform any treatment decision? Most probably not.
Next step it would seem would be to start some sort of global treatment, probably basic androgen deprivation therapy. See how you tolerate it. And sustain it for a year or two.
Then wait until your PSA hits 2.0, then perhaps consider a scan with then current technology.
I would also start doing monthly PSA testing because... why not?
And make sure to put your self on a sustained, but moderate level of resistance training to protect your muscle mass.
Your doubling time is in the ballpark of one year thing that translates to low-mild aggressiveness.
Check what I am currently doing here:
healthunlocked.com/prostate...
There wouldn't be any ship sailing if, for a couple of months, you tried something similar.
I am now in dialog with the National Cancer Centre in Korea. I will report their recommended response when received.
I think it will include some form of ADT and a PSMA PET-CT scan.
I like your ADT approach.
Thanks for input.
You probably know that BCR after radiation is nadir+2.0, and you aren't anywhere near that. You are still subject to all the same benign causes of PSA increase. If it continues to go up,to say 1.5, your next step is an mpMRI. You have to find a radiologist who is experienced at mpMRIs in irradiated tissue.
Get a F18 PSMA test. At psa 0.6 my PSMA showed an infected lymph node.
What happened then?
I've had SBRT. I'm still waiting to see if it worked
Hope the SBRT did its job. I have heard back from Korean NCC. They suggest I wait 3 months and repeat PSA test. Apparently my low nadir PSA test after PBT was a lot lower than most. The average is near 0.5 PSA . As mine at 0.75 is not a lot higher, is why they recommend a further test in 3 months.
Proton Beam vs Rapid Arc Image Guided Radiation Therapy
Not diagnosed yet, but in research mode...looking at proton therapy especially
Proton Therapy after Robotics and PSA
Immediate vs Deferred Treatment of BCR after primary and adjuvant therapies. ADT, now or later?
Looks like I overreacted 
