Briefly, I had Radical Prostatectomy in February of 2018, ADT with Salvage Radiation ending in September of 2019 and undetectable PSA until August of 2022 when it increased to .09, then .12 in October, and .22 in December. Finally, .34 in March 2023.
I just received this message from my Oncologist.
"Your recent PSA has continued to increase, now to 0.34 from 0.22. I suspect recurring cancer, however your PET scan earlier this year did not show anything. Another PET would be helpful to locate the site or sites of prostate cancer that would be helpful for planning any future treatment. If you have minimal disease you could be a candidate for very localized radiotherapy which could control the disease for a reasonable time. Another approach would be to restart anti testosterone therapy which would need to be continued indefinitely. In either case, a PET scan that shows disease would be useful to follow your response. I suggest repeating another PSA in 2 months and assuming it increases further, ordering another PET scan."
Any thoughts on my next steps or questions to ask during our consultation with my Oncologist?
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Imp4t
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I don't know if radiotherapy will accomplish anything, but I know that even a year of intensive hormone therapy will. That was proved recently in the PRESTO trial:
The ADT reduces the PSA value but not equally well the PSMA expression. Therefore, if you get ADT you have a very low PSA value but only a reduced PSMA expression. My experience is, if you had a PSA of e.g. 10 ng/ml before ADT, you will have enough PSMA expression for very low PSA values while on ADT. So while on ADT you can get a positive PSMA PET/CT with very low PSA values.
Pet scan early this year? 3 months time? and two more soon......Hey I'm definitely not a doctor but will your medical coverage that many in that short of time? I guess do them and follow his lead......God Speed!!!
Keep in mind that when cancer spreads, it may take quite a while for growing tumors to become visible on any scan. I agree with Tall Allen - "I don't think it's a good idea to wait for metastases to grow big enough to detect." I had Taxotere plus prophylactic radiation of additional lymph nodes when my PSA hit 0.06, and that gave me 4 years of undetectable PSA.
p.s. I monitor my PSA monthly when it starts rising, because the trajectory is much more meaningful than absolute values.
Looks like your age indicates your on Medicare. If so you can see what Medicare will pay for.
For those not on Medicare Private insurance like BCBS may deny you a PET scan until you reach PSA 1.0. They very often require a CT scan and Bone scan BEFORE they approve a PET scan.
So a low "undetectable" PSA is a normal hoped for condition while on ADT. How long were you on it and when did you come off it?
Your rate of increase, and whether that increases steadily, or the increases become greater/faster over time, or they become smaller/slower over time will give some indication of the doubling time.
I'm been down a similar road. RP 2017, ADT 4 months. PSA rising at 0.5 per month increasing to 0.25 per month. Whole pelvic radiation in 2019 at PSA 3.9. ADT for 24 months. PSA nadar <0.01. OFF ADT July 2021.
Currently PSA 0.881 rise has been SLOWING Some months no rise at all. Now Typically a rise of 0.05 per month.
Scheduled for PSMA scan in June 2023. Expect to be at 1.0 by then.
I get LabCorp ultrasensitive PSA now every two months.
I believe you should be seeing a doctor and Hospital with the intent for targeting your cancer not palliative care, and you should find out where it is BEFORE you go back on ADT. ADT won't cure you so getting on it will eventually fail First I would recommend staying off ADT until you find out where your cancer is. It may still be treatable. You need a physician who is enthusiastic and realistic about this approach. Your scans will determine if treatment to eradicate your PC is possible.
It has been noted that the mRNA Covid vaccines have had an effect on Prostate Cancer. I've been meaning to insert my Covid vaccination dates into my very detailed mostly monthly ultrasensitive record to see if my no increase months correlate with vaccination.
Things are happening incredibly fast with cancer research including Prostate cancer in areas such as gene therapy, CRISPR, mRNA, CAR-T in the last couple years due to the new technology used in the Covid vaccines.
It very likely that Prostate cancer and other cancers will benefit for this exploding research. Potentially new treatment will allow us to live out our lives in a controlled fashion with few if any side effects, with the chance of outright cures for many people.
The world of medicine is changing at light speed to personalized gene therapy. Today's treatment will be considered the medical dark ages in not too many years from now.
My interpretation is your doc is on common path, especially given your age, to yield time and obscurity to this beast. This is what I would ask (challenge). In part, I base my perspective on my experience with having six cancerous pelvic lymph nodes confirmed by surgery, at 0.11; many a docs told me nothing to worry about at 0.11 post RP and salvage RT. All the best!
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