Score is rising

[Pizzle123]

Hi all, been a while since I have posted. Quick update. 2018 PSA 200. Had ADT then ERBT. PSA went down to 0.039 then I had a holiday from ADT for 12 months. PSA started to rise fairly rapidly and was at 3.2 in June. I had another PET PSMA scan and my RO was concerned so here we are Gleeson 4+5 now. I'm apparently in line for surgery they are referring to as salvage surgery. A rather delicate op due to the fact that the radiation has destroyed the prostate tissue so they tell me. The urologist say they only perform this particular op about once a year here in Australia. should I need to be worried? regards to all Glenn. aca Pizzle123

[Scout4answers]

I would try to find someone who performs more than one of these per year if you decide to follow that path.

[Tall_Allen]

Hi Glenn,

First, you have to check for distant metastases with a PSMA PET scan. That will dictate whether it is worthwhile to try for a curative salvage therapy.

Salvage surgery is a really really bad idea. There are much better options, probably salvage whole gland SBRT, if you can find an RO who does it:

prostatecancer.news/2016/08...

If there are only one or two sites of prostate recurrence, focal brachytherapy can be an option.

prostatecancer.news/2017/09...

As you've learned the hard way, there are no "vacations" when you are trying to be cured with radiation. "Vacations" select for the most resistant cancer cells. So, you will need 2-3 years of hormone therapy - ADT along with abiraterone, enzalutamide or apalutamide, if you can get it (but it will be hard to get outside of a clinical trial).