This is my first post asking for opinions for further treatment. Had radical prostatectomy at Keck USC from Dr. Monish Aron in November, 2018. Psa was subsequently .02 for close to 3 years.
Climbed to .08 in Jan. 2022 then .10 in March 2022 Most recent psa was .239 on 8/5/22
Seeing my urologist next week. Wife would like me to get PSMA test soon. Just wondering what
others would suggest at this point. All responses are appreciated.
Jerry
You can use this nomogram to predict whether a recurrence can be treated successfully with salvage radiation therapy. mskcc.org/nomograms/prostat...
It's too early for PSMA. What were your pathology results?
Allen- Your response confuses me AS IT APPLIES TO ME. Dr. Rathkoph had me get the PAMA after my PSA increased over a year’s time and started doubling writhing 3 months time but had only reached .32. As a result of the PSMA, as indicated in a previous post of mine, she had me get my largest tumor radiated as she felt THAT tumor was the one for the rise in my PSA. About 4 weeks post radiation my PSA dropped to .05. (I get my next follow-up labs tomorrow).
Should she not have had me get the PSMA at that time? Was the info she gleaned (that my PSA increase was likely do to my largest tumor) unreliable?
As always- Thx Much
Yes, rapid doubling time may show up. In his case, the very slow rate of progression indicates not-very-active cancer. He should at least have a confirming PSA in a couple of months.
I'm not sure that zapping that met had any utility for you (other than local control and lowering PSA) - hopefully it did. I think it is tragic when men forgo systemic therapy just because they have "treated PSA." We know that systemic therapy slows progression, we don't know if zapping metastases does.
PSMA PET/CT definitely. With your PSA doubling time somewhere 5 to 6 months it has a good detection probability. Take some lutamides (Bica or Enza) for 2 to 4 weeks before the PET scan as they are, believed to, enhance PSMA expression.
It is important that your therapy is guided by a medical oncologist and a radiation oncologist. The urologist already did his/her job. There are good MOs and ROs at UCLA.
You have a BCR and further treatment is indicated. I would request a a PSMA PET/CT to see where the cancer is located . This test will help in planning the salvage radiotherapy. With a PSA of 0.2 the detection rate of a PSMA PET/CT is around 52% so it is not too early to request the study and it may lead to changes in the treatment plan.
renalandurologynews.com/hom...
Consider radiation to the prostate fossa plus whole pelvis radiation and at least 6 months of hormone therapy. Things may change depending on the result of the PSMA PET/CT
Not enough information. Need pathology report results.
Or you can just Tango65’s advice and go get some better medical care. But you will still get valuable input here-more info, better value.
drjg, You should provide your post surgery pathology as requested and you should make appointments with the very best MO and RO available. I'm about your age and also had RP in 2018. I'm still undetectable and my post surgery pathology was very good. I believe you have a BCR. If I ever have a BCR, I plan to get advice here and definitely visit the best MO's and RO's I can find. Good luck!
Thanks for all of your advise and input. My post surgical pathology report is as follows:A: ( L) neurovascular bundle 1, PROXIMAL: adipose tissue and nerve, neg for malignancy
B: ( L )NV bundle 2, MID: fibroadipose tissue and nerve, neg for malignancy
C
L) NV bundle 3, DISTAL fibromuscular tissue, neg for malignancy
D: Prostate:
-Prostatic adenocarcinoma, acinar type with hormonal therapy partial treatment effect (ypT3a N0)
- tumor site: bilateral and multifocal
- tumor volume: involving approximately 30% of prostate tissue
- extraprostatic extension: identified extensive, bilateral lateral-posterior
- lymph-vascular invasion: focally identified
- perineural invasion: identified, extensive
- surgical margins: positive, very focal, at L superior posterior margin
-maximal linear length of this positive margin is <1mm
- bilateral seminal vesicles uninvolved
- all pelvic lymph nodes negative for tumor
- periprostatic fat, benign adipose tissue
Thanks again for all of your input.
Drjgs
My situation is similar to yours, but not identical (see bio). I would strongly suggest seeking guidance from RO and MO, as others have also indicated.
My urologist raised the flag as my PSA started to rise after almost 3 years post RP of undetectable, and referred me to an RO. I have not seen my urologist since. 33 factions of IMRT to prostate bed, completing 9/21.
PSA continued to rise, was referred to an MO, who sent me to PSMA PET scan (PSA 0.6), and identified pelvic lymph node hot spots and one rib hot spot (each very small). Just received 3 month Lupron shot in conjunction with at least 2 years of abiraterone/prednisone starting 8/22. At the same time, also started another 30 factions of IMRT to entire pelvic area, as well as SBRT to rib hot spot.
The hope is that radiation will address hot spots, and systemic ADT will address those invisible metastases that are most likely there. In hind sight probably should have done initial IMRT to entire pelvis, instead of just prostate bed. Hindsight is 20/20!
I am by NO MEANS an expert on any of this, but again would humbly suggest connecting with RO and MO and being as aggressive in your treatments as you can, to try and stop the spread now, instead of waiting and hoping. Hope this helps, as this is all very confusing and overwhelming.
Blind irradiation became sub-optimal after the advent of the PSMA PET scan. My post: "Contradicting silly doctors' parrots" lays down the arguments.
Rising PSA after Prostatectomy
Time between Radical Prostatectomy and Metastatis
Radical Prostatectomy - Maybe It's Time is Past 
Potential biochemical recurrence post radical prostatectomy, looking for perspective on the outcomes and treatments. 
