My husband 59 came across this article that has completely upset him even more. He had RALP 6 weeks ago and we were devastated to learn his first PSA was .50 ( pre surgery PSA was 7.8.). His surgeon was clearly bummed. He will have a PSMA scan in the next few weeks.
He is a Gleason 9, RALP biopsy results were hopeful, negative margins, no lymph or SV invasion. Initial bone scan was also negative and MRI didn’t show any activity outside the prostate. Do any of you have any experiences that may help us understand what going forward might look like.
Quite possible the PSMA PET/CT will give you an answer.
If there is cancer in the pelvis it could be cured or have a long term control with radiation to prostatica fossa and whole pelvis radiation and 2 years of ADT plus abiraterone.
If there were distant mets the situation if different but many treatment are available, particular triple therapy with ADT, chemo and abiraterone.
What was the time frame from surgery to the first post op PSA?? It is possible that you may have checked too early and another PSA test may be helpful before starting additional treatment.
His first post op PSA was 6 weeks after surgery. I had hoped his surgeon would have suggested a retest but he said by 6 weeks it should have been undetectable. I suppose given he is a Gleason 9 there is more reason for concern. I hope the PSMA finds the issue.
if it’s any consolation, I underwent RP with a good path report as you and at 6 weeks my post op PSA was .3. I was really upset and frankly thought I went through surgery for what?? Had post op PSMA scan which was normal. Repeated PSA scan 2 weeks later and was 0.00. Has remained undetectable since. Unfortunately this a roller coaster that no one wants to be on. Lots of worries. Would encourage you to get a decipher test on your pathology, which may help you make decisions forward. Hopefully you just got the test too early!!
Sorry to hear that, but there is still a chance to cure the disease with additional treatment . My post op PSA was 0.5 also. For me the PSMA scan was important as it identified two pelvic lymph nodes. My treatment involves chemo (in progress), radio therapy with extra doses to the lymph nodes plus 2+ years ADT plus abiraterone. My starting PSA was 76 before prostatectomy and down to 0.07 after 6 weeks ADT. At a minimum radio therapy plus a course of ADT as agreed with your medical team will be required. Best wishes.
Also, if you dont have genomic testing I would get some done on the sample (its stored at the surgery center). A GS 9 with a low genomic score is a different condition from one with both GS 9 and high genetic markers; I got a Decipher and it helped me decide on more treatment when I could have laid back and watch the PCa develop...I can only hope that your GS 9 could come back with a low Decipher, or other genetic test, meaning the cell aggressiveness is not as bad as the visual Gleason category. My condition was reverse; lower GS and near max score on Decipher...
Bills didn’t go below 3 after surg. MRI hadn’t shown anything prior to surg. Quite the different story when they got in there. Was in pelvic lymphs, margins, seminal. MRIs aren’t always sensitive enough to show. ( 4+3, PSA 5.5 prior). Fortunate in getting to Dr. Kwon at Mayo Rochester who is top in recurrance/biochemical failure). .2 is the definition of biochemical failure. C11 choline pet scan ( this was 2015) did find it spread.( lymph in chest). Dr. Kwon has some videos, both basic and from speaking at conferences google Dr. Eugene Kwon utube if interested. Read the PEACE1 study. He was started on chemo as first step, then 6 mo zytiga, Lupron, prednisone, then 37 radiation and meds, then meds for a year. Has been non detectable no evidence disease 6 years, no cancer meds or treatments 5 years. Has PSA every 6 mo, just reduced from 3 mo, and yearly pet scans. Mayo Rochester has both the c11 choline and PSMA pet scans. Docs have differing opinions on chemo and following treatment and the backup of the PEACE 1 study.
I agree with Tango above. I would take an aggressive approach based on age and how aggressive the cancer (Gleason 9). Most would agree that salvage radiation is called for, but there might be some differences on ADT. Personally, I would hit hard and hope for a cure. If the scans show distant spread, than triple therapy ADT, Docetaxel chemo and Abiraterone is the best option.
Here's an article that talks about adding ADT to salvage radiation.
I don't want to give false hope, but I had a similar situation occur, they had ordered the wrong test and I did a repeat two weeks later at Moffitt and it was undetectable.
Maybe some rough waters to navigate ahead. Agree with Tango above, SRT, salvage radiation therapy, to prostate fossa and full pelvic lymph node fields with short term ADT could well be curative. Reconfirm PSA on repeat test and the PSMA scan will provide what you need to know. Also get genetic analysis of the removed prostate gland with IHC.
My PSA after surgery was .9 with GL 9. My doctor was very pessimistic which put me down in the dumps. Went on Lupron and at my request, Zytiga 2 months later. Immediately went to <.1. Had SRT about 8 months after my surgery waiting for my incontinence to get better. It did. Went on HT vacation after 24 months. Still undetectable almost 4 years after surgery.
From my research into this, any man that falls into the high risk (of recurrence) category should be steered away from surgery as probability of cure drops off a cliff in that zone.
This is due to micro-mets that are not detectable but that can reside outside the surgery margins.
Radiation therapy can sometimes mop-up the nearby micro mets.
Most of the urologists i spoke with seem dangerously uninformed, constantly telling me that surgery and radiation both have identical curative probabilities.
Hi JLR65. I was 54 when I had my RP September 2021. Gleason 9, SVI, EPE, PNI, bladder neck invasion, intraductal carcinoma, +margins, 8/27 metastatic LNs, so was pT3bN1. Six week post RP PSA was 3.92. Insurance denied PSMA PET. Began two year course of ADT+abiraterone November 2021, then 40 sessions of IMRT January-March 2022 - whole pelvis/prostate bed/anastomosis. My PSA has been <0.02 since February 2022, halfway through radiation.
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