should I be worried?

[Jroc1]

looking for some insite as to what I should expect going forward given the state of my condition. Had prostatectomy in 2019. Gleason 4+3. PSA before operation was 3.4. Remained undetectable for 4 months, then rise to 1.9 over 4 months. PSMA scan detected one lymph node in pelvis. Went for 40 rounds of radiation with lupron and Zytiga for 8 months ending August 2020. PSA remained undetectable for 1 year ending August 2021. Since then PSA rose over the next 14 months to 1.5 in Nov 2022. No treatment at all since Aug 2021. PSMA IN Dec 2021 when PSA was .18 showed nothing. MRI and CT in July 2022 showed nothing. I am now scheduled for another PSMA in Feb . Any thoughts of what I should expect.? Thank you

[Tall_Allen]

You wrote: "PSMA scan detected one lymph node in pelvis. Went for 40 rounds of radiation with lupron and Zytiga for 8 months ending August 2020." What was radiated? Just the prostate bed and the one node? Whole pelvic radiation? I hope it was whole pelvic.

You have a type of prostate cancer that doesn't put out much PSA. T scans are very PSA-dependent so it is unlikely that you will detect anything with it at such low PSA levels. Maybe try an FDG PET/CT scan .

[Jroc1 in reply to Tall_Allen]

the whole pelvic region incl the node. Why do you think the cancer does not emit much PSA? The Psma scan picked up the node at about a PSA of 2. The second psma scan did not pick up any cancer but that scan was done when PSA was no more than .2.

[Tall_Allen in reply to Jroc1]

"Why do you think the cancer does not emit much PSA?" Because you wrote "PSA before operation was 3.4. " and that was with a positive lymph node.

[Fightinghard]

Think lupron or equivalent plus second tier blocker med long term

[ImaSurvivor1]

Jroc1: With your PSA probably back up over 1.5 by February, there is a good chance that your cancer will show up on the PSMA PET/CT. It's not certain, of course. There are some prostate cancers that don't express PSMA. So, those don't show up on the PSMA scan. I've read that about 20% of prostate cancer don't express PSMA. If it doesn't show up, don't give up. There are new diagnostic tools coming on line all the time. I was just in a clinical trial that uses a different radiotracer injection to "light up" the cancers (Cu64 Bombesin). It detects cancers that don't express PSMA, but it's still in trials. So, it won't be available for a while, assuming the trial is successful.