PSA keeps rising

[John347]

My PCa timeline:April 2022 - DX with PCa, Gleason 3+4, PSA 18

Jun 2022 - PSA 28, given 3 month shot of lupron

Aug 2022 - 20 sessions of IGRT

Sep 2022 - PSA 0.56

Dec 2022 - PSA 1.6

Feb 2023 - PSA 5.3

Mar 4, 2023 - PSMA PET scan shows a single spot ("moderately tracer-avid focus at 6th rib ... suspicious of bone metastasis")

Mar 21, 2023 - PSA 8.5

I will meet with my oncologist next week to discuss treatment options.

My questions:

1. Should I seek first confirmation that the spot at the rib is indeed cancerous before commencing any treatments?

2. If yes, what sort of tests or scans will be able to confirm that it's indeed cancerous?

Isn't PSMA PET scan supposed to be most accurate in revealing any met?

3. My current oncologist will likely recommend ADT and radiation. I'm not too happy with my oncologist and will probably request a change which will mean a few more weeks delay in treatment.

Should I get ADT shot immediately? Would a few weeks delay in commencing lupron shots or radiation make any difference?

Thanks for any advice.

[Izzygirl1]

Did you have a bone scan done back on April?

[John347 in reply to Izzygirl1]

Yes Izzy, I did have both MRI and bone scans last April but the results were inconclusive.

[Tall_Allen]

1. Yes

2. There should be a correlate on conventional imaging. If large enough, biopsy. If it shrinks with hormone therapy it was a true met. PSMA PET scans have only about 50% specificity.

3. Getting a Lupron shot will enable you to diagnose the met.

[John347 in reply to Tall_Allen]

Thank you Allen,Is the rising PSA an indication that the spot in the rib is likely cancerous?

What other possible explanations are there for the rise?

[Tall_Allen in reply to John347]

It may be due to cancer you cannot yet see.

[treedown in reply to Tall_Allen]

I see that as 1 problem with spots only seen on PET, I doubt the insurance company will approve another scan just to see if Lupron shrinks them. So its just a wait and see until it shows up on conventional.Question: Once mets do appear on PET is PSA alone still a good way to monitor?

[Tall_Allen in reply to treedown]

PSA was the best way to monitor in most situations, irrespective of PET.

[treedown in reply to Tall_Allen]

I have read more than once that once metastatic scans are required and that PSA alone can't be trusted. Maybe I read that wrong.

[Tall_Allen in reply to treedown]

PSA is the basic. Scans,not necessarily PET scans, once in a while, or if you are the rarity for whom PSA is not a good indicator. What is your situation?

[treedown in reply to Tall_Allen]

Newly metastatic on PET only. Started ADT and Xtandi. MO said CT and bone periodically but wasn't specific. However, he also said I would get a PET at PSA at .5 and it turned out I had to wait 8 months until PSA 2. So not sure when insurance would agree. Also not clear when chemo is appropriate as it is listed as 1 of the 2 options on NCCN guidleine where I currently find myself.RO said PSA only when he told me no to radiation.

[Tall_Allen in reply to treedown]

Why isn't PSA a good indicator for chemo, especially if your PSADT is rapid?

[tango65]

Do you know the SUV of the finding in the rib?

There are false positives in PSMA PET/CTs in the ribs. I had several rib mets diagnosed, never confirmed in subsequent PSMA PET/CTs or in MRI studies.

If the SUV is lower than the SUV of the liver, you could request a 3 T MRI study of the rib to see if the MRI confirms that it is a metastasis.

[John347]

Thank you tango65.

The scan report gives my SUVmax as 6.2. Does that show that it is likely cancerous?

[RMontana]

See if this helps...traditional bone and CT scans have their place....I recall it mentions their use even in the age of PSMA PET...

healthunlocked.com/active-s...

Before going on ADT take care of your ED issues...ADT is destructive to penile tissue. If you want my history with ADT use without thinking of ED downstream let me know. TNX

PS have you had your PCa graded via Decypher...for me GS is the type of car your PCa will use as it travels forward and genomic testing, like Dechpher, is the speed at which it can travel. If you have not had genomic testing consider it...it gives you another arrow in your quiver...it also can be used to determine WHO will benefit from ADT!

healthunlocked.com/active-s...

PSS last...PSA is not as important as PSA doubling time...your's is below 6 months; this is not optimal...take a listen.

healthunlocked.com/active-s...

BUT all is not lost...the hard nut to crack w this disease is knowing enough to pick the right treatment from the right doctor at the right time, making that call then adjusting from the results and getting on w our lives...all the best...

[j-o-h-n]

I too am befuddled with your situation..............Time for the two headed coin......

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/26/2023 12:07 AM DST

[NecessarilySo]

I believe it is a metastasis on the rib. I have had a couple of these. One of mine did not go away with Lupron, but it did not worsen with time. It was not painful, except if I put my finger on it, Recently I eliminated it with heat and magnets. Anothr started recently on the opposite side. I treated with heat and it is reduced. I recommend you try applying hot shower to the area, 110 degrees, for about a minute. If it returns, or stays, repeat.