Post SBRT rise in PSA

[FrankyB4]

I am recurrent oligo. In June of last year, a plarify PSMA detected a solitary met at C6. My psa at that point was about .43. By September it was .54 and I had SBRT to C6 in November,21. Never been on HT. My psa declined to .05 by about May,22 but by August has now risen to .08.

What now?

PSA too low right now for another PSMA. HT has a shelf life so would rather not use that bullet until I have to. My RO doesn't usually start HT until the psa is more in the 4.0 or more range.

I read a recent paper to the effect that BCR after SBRT requires nadir plus 2 but I don't want to wait that long.

I am meeting tomorrow with my RO but value your input. My RO seems a little too accepting of the inevitable for my tastes.

Do I just wait for the psa to get back to around .5 and do another PSMA?

(I do have a spine MRI scheduled for Tuesday- standard after SBRT. But, in the past, the MRIs had trouble even confirming the met at C6 seen on the PSMA.)

Thank you.

[Tall_Allen]

"HT has a shelf life so would rather not use that bullet until I have to. My RO doesn't usually start HT until the psa is more in the 4.0 or more range." There is evidence that hitting it heavy, early - even for a short term- delays progression.

ejcancer.com/article/S0959-...

ncbi.nlm.nih.gov/pmc/articl...

meetings.asco.org/abstracts...

(Keep in mind that you are non-metastatic by the bone scan/CT definition used in those trials)

"I read a recent paper to the effect that BCR after SBRT requires nadir plus 2 but I don't want to wait that long." That doesn't apply to you. It only applies to men without metastases.

[FrankyB4 in reply to Tall_Allen]

Thank you.

[MateoBeach]

You know that your cancer makes PSMA as was shown by the one oligo-met. And the small amount of PSA suggests further microscopic mets are present. (2/3 of oligo treated with SBRT have recurrence elsewhere within 2 years). So systemic treatment to address it is wise. I was in same situation in May of this year. Not tolerating ADT (severe sarcopenia), I chose to go to Perth for molecular targeting with a monoclonal antibody variation of Lu177, Lu-PSMA-J591. Details in my previous posts this year.HT with both an ADT plus an AAR drug would be the SOC. And indeed that does extend survival and delays progression. But also creates the condition that leads to castrate resistance in most cases, and carries substantial side effects, as you clearly understand.

Other options would be chemotherapy. Or modified BAT (which I am also doing and have posted about). Difficult choices to sort out. Good luck. Paul

[FrankyB4 in reply to MateoBeach]

Thank you- I have followed your Perth posts. Good luck to you as well.

[Grandpa4]

I think radiation is more effective if combined with ADT. I think you need an oncologist who specializes in prostate cancer.

[ishitasen]

Yes, you are correct, your PSA levels are too low and a PSMA PET CT scan may not be able to find any active disease. If you are asymptomatic, then a follow-up PSA after 06 - 08 weeks may be worthwhile.

[FrankyB4 in reply to ishitasen]

Thank you. I did do a follow up PSA 6 weeks after the .08 result and it has now risen to .13. So, it has risen from .05 to .08 to .13 in about 3 months. The threshold for a PSMA that my doctor has used in the past is .50 so I am watching until then. MRI of spine in August was negative. Thanks again.