PSA persistance

[runtrails]

well, not the result I wanted. Just got my reulsts back from first uPSA test since surgery. (June 2 22)

.69.. have oncology apt next week. Is this indicative of HT and RT right away? Haven't really been nervous until now.

[Enasxristos]

Radiotherapy to the prostate bed and pelvic lymph nodes plus 4 to 6 months of hormone therapy is now been touted as the best way.

[Grandpa4 in reply to Enasxristos]

I think the current recommendation is to remain on antitestosterone drugs for 2 years but I am happy to consider otherwise. I am currently post radiation on Lupron and abiraterone. No real data on abiraterone in this situation but my MO thought we should go with it. I am not experiencing many side effects.

[Alturia]

Yep, that's what happened to me back in April. I went onto Eligard, Abiraterone, and prednisone right away and will be on them for at least 24 months. I have pelvic and lymph node radiation scheduled for November. I delayed the radiation so I could go on a couple of trips that had been planned. I was advised that waiting to do the radiation was not a problem. BTW my PSA is now undetectable.

[runtrails in reply to Alturia]

Thanks..why are we awake? 12:42 AM in Washington.

[Alturia in reply to runtrails]

Well, I'm awake because I am on the Isle of Mull in Scotland so 5 hours ahead of you assuming you are in DC. If Washington state then I am 8 hours ahead of you.

[KarkMuzio in reply to Alturia]

your just north of Jura....my fav single malt!

[runtrails in reply to Alturia]

Washington state. I have always wanted to visit Scotland

[Hidden]

Psma pet to help identify where the potential source is. Hopefully a node or the area near where your prostate was lights up like a Christmas tree and nothing else. Then radiation to the whole pelvis, paying close attention to the hot spot(s), along with 24 months of hormone therapy.

[Tall_Allen]

Yes, persistent PSA that high is a sure indication for salvage radiation +ADT. But first, get a PSMA PET scan to check for distant metastases.You can use ADT for 7 months before starting radiation to allow tissues to heal.

[Grandpa4 in reply to Tall_Allen]

Could you comment on the length of antitestosterone therapy that is optimal for the response to radiation therapy. Seems like some people say 6 months while others say 2 years. I hear some British researchers are saying 3 years.

[Tall_Allen in reply to Grandpa4]

It depends on the patient's situation - shorter for salvage radiation, longer if there are known cancerous pelvic lymph nodes.

[runtrails]

Thank you for the response. All a little overwhelming. Trying to soak up as much data as I can. I feel well, have no know health issues except some higher cholesterol (and I understand statins help anyway) and am pretty fit, so hopefully that will help mitigate to some degree S.E from ADT

[London441 in reply to runtrails]

I’m sorry for your high PSA after surgery. .69 is not good for sure. However, as has been mentioned if it has not spread outside the area you still have a very good chance to eradicate it.

Even if it has spread there is much that can be done, it just shifts to disease management, hopefully for a very long time.

Either way, you can expect to be on ADT for some time at least. You have a distinct advantage with this one.

Your fitness will not only kill or strongly reduce ADT side effects, it will help you in many more ways, and you will need it. Exercise will improve circulation, control BP, preserve bone health and well regulate blood sugar levels the ADT wreaks havoc with. If you lift weights (necessary) you’ll be fighting ADT induced sarcopenia too.

And especially cardiovascular disease, much more likely to kill you than anything else.

You say ‘you understand’ statins lower cholesterol, but do you take them?

[runtrails in reply to London441]

Yes I am on a Statin drug now

[London441]

Great. Do you know your cholesterol numbers, your triglycerides, hemoglobin A1C, blood pressure? Testosterone? Body composition and bone density (via Dexa scan) too.

You should have all these updated before you go on ADT. You should get them on the regular anyway of course, but especially at the start of ADT.

The potential detrimental effects of ADT, for all the important good it does, is no joke. Monitoring your health when on that stuff is everything.

[runtrails in reply to London441]

I had a complete blood count Etc not long ago but it did not include anything about bone density. I believe there is an order for that from the oncologist after my initial visit this coming week. I will ask about the dexa. I lift weights 3 days a week swim two days Run 3 days or more. But this year I have only been running about 10 to 12 miles per week. Pre-covid I was running 20. I do understand I need to change my lifting program from high rep to heavier weight bearing. 5 Ft 9 and change 173 lb

[London441 in reply to runtrails]

You are far ahead of most guys. Take advantage of it! Train for the ADT as if the Olympics, centurion decathlon, whatever. Great luck to you!

[Hailwood]

After surgery, my first PSA was 4.6, and then after more scans including PSMA, I'm on Lupron and Erleada, PSA has stayed at 0.02 with T at 0.5, I still work full time and the mets are stable after almost 2 years. Hang in there and take each day on its own and dealk with what is in front, not what you think lies ahead. Stay strong

[runtrails in reply to Hailwood]

Did you to radiation as well? Lupron.. did you do the 90 day injection or a different version?

[Hailwood]

No radiation as once they saw the Mets were scattered over the belly, it had to be systemic treatment as opposed to a surgical or radiological option. I do the 90 day Lupron

[mike__c]

Not too different from my situation in Jan. 2021. Though I had SV invasion (no bladderneck extension) and some lymph nodes. PSMA or in my case Axumin scan should be next to identify what's left and then ADT right away followed by salvage radiation. I've read some studies that conclude that beginning salvage treatment as quickly as possible plays a significant role in biochemical free survival. So, get on that scan and ADT a.s.a.p. before your radiation (which can wait a few months).

If you are in a "low/moderate" risk category, ADT would last for 6 months with or without aberatirone.. If you are "high risk" , then 2 years of adt with or without aberatirone.

I was high-risk for several reasons and chose 2years adt and abiraterone. I made it for about 4 months on abiraterone before side effects caused me to quit. I made it 18 months on Eligard before the zero-testosterone life caused me to quit. Needless to say i have been psa<.05 (undetectable) since after the salvage ADT began.

[runtrails in reply to mike__c]

Thank you.

[mike__c in reply to mike__c]

I have to say, if I had it to do over again, despite being in the "high-risk" category, I would have opted for 6 months of ADT with abiraterone. Long term ADT is devestating if you are not 100% prepared for it. I am trying to swim out from the results right now and it is hard.

[runtrails in reply to mike__c]

What ADT treatment did you have? Lupron? Eligard? Zoladex?

[mike__c in reply to runtrails]

Eligard.

[Cooolone]

The protocol you mention is what the SPPORT Trial used, for RP patients with recurrence or persistence post surgery, salvage therapy of a short course ADT (6 months) and RT to the Prostate Bed and Surrounding Lymph nodes. Very good results for a high percentage of patients. Look at the trial data and see for yourself.

Best Regards

[runtrails in reply to Cooolone]

Ill check it out

[TJGuy]

You need to make sure you've recovered from any incontinence issues from RP before undergoing Radiation.

[runtrails in reply to TJGuy]

Oddly enough..after cath removed I wore protection just in case for a week. Never had issues..must have been the 10,000 kegels.