Hello everyone .well my Husband and I had his Dr appointment yesterday. I'm not sure how to feel about it. Since his PSA has doubled each month for the past three months but is 0.3, which the Dr did say is a very fast doubling time, and he assumes it will keep up at that pace. So he ordered a bone scan and a CT scan. Also, he will have another PSA test at the end of the month and if his assumptions are correct about the doubling time that will bring him to 0.06 PSA he will have the PSMA PET scan on Dec. 2. and from my understanding, he will have a hormone shot as well at that time. They did say he could participate in a trial but his PSA would have to be a 2.0. My husband has over-the-top anxiety which he is medicated for but doesn't want to wait for his PSA to get that high. So I guess now we just have to wait. I'm not sure if we should get a second opinion. My husband trusts his Dr. and likes him which hasn't been the case for several others we have come across. what will the bone scan and CT scan show that the PSMA PET scan won't?
Back From the Dr.: Hello everyone .well... - Advanced Prostate...
Back From the Dr.
All of the therapies for recurrent PCa are based on bone scan/CT, which is why he needs that. With a rapidly increasing PSA and no distant metastases, there is evidence that short term use of a second generation hormonal therapy can slow progression:
prostatecancer.news/2022/09...
OK great I think that is the plan. what if there is metastases?
If there are metastases on a bone scan/CT, lifelong ADT is indicated.
Old school doc, out of tricks bellow 2.0. Will not spend time to put out a fire, in its infancy, using buckets of water. Will wait for fire to go wild and call the aerial firefighters.
Granica, try this article...I think from what I read that Bone and CT scans are/ have been replaced by PSMA PET...the latter will or has become the SOC (standard of care). Its not wrong to get them all but I personally would not rest until I received and saw a PSMA PET scan...above 0.2 PSA they are in the 40-50% Sensitive range but Specific for cancer in the 90% plus...meaning if they find a tumor is PCa!
My plan if my PSA starts to rise after I come off my 21 months of ADT is to hit the PSMA PET starting at 0.15, then do one at every interval of 0.05 until I find out where its growing, then treat it. I like you do not want to wait for the PCa to grow so that I can find it in one session...yeah not a good idea...TNX
healthunlocked.com/active-s...
Thank you for your advice. I agree with you how important the PSMA scan is. You are correct about it being 50% at my husbands level but he said if we waited one more month the chances rise to 75 % once PSA goes to 0.6 which would be double from last month. He will have bone scan Nov 11 so I pray they don't find anything. But the amount of pain he has been having I'm not so sure. Thank you for your help.
Would seem simple n practical.I'm electrician and fault find nasty little problems.
I use all tests at my disposal to issolate a problem.
Starting cheap simple experience(but I can make assumptions)presumptions on that!!!!
So I scratch my head why all tests that can be done are not!
So far I had a pelvice MRI
A bone scan.
A biopsy from prostate.
And blood taken.
I'm on chemo! Will it or radio therapy work???
Who knows?
Maybe more tests at begining.
Like I do at work.
It's broke, now it's fixed, here's before during after....
So I'm going keep pushing for pmsa pet scan.....
Why on earth wouldn't we want clear pictures of what's going on???
if the bone scan and CT are negative for mets, good. But there is clearly more cancer somewhere. Question is where and how many sites? PSMA PET scan is more sensitive and is usually good at his PSA > .50. If oligometastatic (fewer than 5 sites) SBRT to those sites can be beneficial.
Would consider and discuss doing docetaxel chemo to slow it down. Also would make him eligible for Pluvicto treatments.
And ask for genetic analysis and IHC testing on the prostate specimen at the site where the prostatectomy was done. They should have it banked. To see if there are specific mutations to guide certain treatments.
If metastasis is found it also makes him eligible for Provenge immunotherapy treatments which are beneficial. Is he on Medicare?
Thank you for all of that information it was very helpful. No he is not on medicare he is only 55 yrs old.
I would take a closer look at the doubling time. Look at the dates of the three samples and see if the doubling time is more like 45 days rather than "monthly". PSA numbers are so low they could be erroneous. The threshold for recurrence is at 0.2 which means he just passed the threshold in early October. If the PSA continues rising say to 0.5 by December, and (I would assume), scans don't show anything until higher PSA, give the ADT a chance to calm it down before any other needless action.
his test dates were ..
10/28/22-0.30
10/03/22-0.16
08/25/22-0.08
07/14/22-<0.1
Purely anecdotal here:
My experience has included short DTs when I have very low PSAs like these, but as PSA rises (into the 2-3 range) then the DT lengthens — sometimes considerably. I’m doing IADT, so I’ve had several opportunities to have low PSA and track things from there.
It’s also easier to see fair amounts of variability in PSA levels when measurements are taken close together (which, for me, has meant “less than 4-6 weeks apart”), and that effect can be more pronounced at low absolute values (which, for me, means less than 1.5).
So at one point, it apparently seemed like a good idea to get my head to explode — so I did weekly PSAs when the values were less than 2. Good times.
All of this is solely from my own experience. I do wish you the best of luck!
The anxiety isn't going to help so ditch that. Pickleballplayer's advice is weird; I've never seen the display during my half dozen or so bone scans so that shouldn't be an issue. More of an issue is claustrophobia from the scanner head being a couple of inches above his head for the first several minutes.
FWIW, until Sept 2022 my bone scan showed metastases then just just went away as if they were never there. Everything that happens, every single test, good or bad, is a point in time and that's all. If you try to look too far ahead, it's gonna make everything worse. IMHO of course.
I agree. were you on any treatment to just make it disappear? That's great news
Erleada every day and Lupron every three months. .
I've had several as well and I never saw the screen.
Anxiety... Not clear if his anxiety is just PCa related or if he has anxiety in general and has been on medication for it? How is your anxiety level?
He has always had anxiety about everything!!!!!! But all of this has put him over the edge at times. I am doing pretty well. Just taking one day at a time.
take a deep breath and be calm. Remember this is generally a slow moving disease.
With PSA readings still that low I am skeptical that bone and CT scans will turn up anything but these scans are often required by insurance before further treatments or a more sensitive scan is approved. Has there been any discussion of 'salvage radiation' to the prostate bed? Wishing you and you husband good luck and a successful treatment regimen.
Thank you. I'm not sure either. But better safe than sorry. A my husbands PSA never went above a 4.0 with prostate and full of cancer.
He has had radiation around the prostate area and one shot of HT. along with a RP
Thank you
If his PSA is .3, I think you mean it will be .6 when it doubles, rather than .06. Right?
Meeting with MedOnc after 2nd Recurrence
PSMA PET scan
Which scan(s) and how do we ask?
PSMA PET Looks Good But PSA Rising 
