I had RALP in November 2019. Gleason 4-3, right seminal vesicle impacted, lymph nodes all clear. Trimix is working although I'm starting to experience scarring and the "carrot effect."
Now my concern has shifted to the disease itself again as my PSA has started a slow rise.
Ultra-sensitive PSA (LabCorp) was .007 then .006. Subsequently switched to Quest where it was <.02 for a couple of years. The last "less than" score was in Sept 2022. Then in December 2022 it was equal to .02 and now three months later =.03.
Urologist said it's time to start talking about radiation and possibly ADT so I'm off today to see a radiation oncologist for his thoughts.
From what I've been watching on here, it seems the thought process is to wait until .1 before considering further treatments. Doc said he doesn't think a PET scan is needed, but he thought I should hit it hard while it's still in the early stages of PSA rising.
Now comes all the second thoughts, is he being over aggressive, am I too worried about hot flashes and side effects of radiation? Should I wait? Should I hit it hard now like he says and hopefully avoid having it spread? Is there anything else I should be considering?
Feeling overwhelmed again.
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jaybojammer
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If there is no benefit to starting early, would there be any harm in starting SRT at .03? Other than standard risks associated with radiation? I’m wondering what the odds are for it to stop rising after three consecutive increases versus the odds that I’m going to need treatment eventually.
Just trying to gather as many facts as possible before making a decision.
Salvage radiation side effects, especially urinary and sexual, can be considerable. It is a bad idea to get a treatment one doesn't need. Your over-reliance on incredibly low PSA is unfounded.
I’m getting a second opinion before starting anything but would be interested in reading up on the three clinical trials you mentioned that showed no benefit. Could you point me to them?
Here's my clinical history, a study of one and the heterogenous nature of our prostate cancer and ourselves. For me, my decision point was the clinical data.
First, my history, the GS, surgery, 18 months to BCR, failure of SRT, PSADT and PSAV. All my clinical history data pointed to an aggressive PCa.
Next was the current clinical data. We had four consecutive increases, we had decided to image when there were three or more increases and PSA was above .5.
The "good" news, the Plarify scan showed only a single PLN. The not so good news, we know there is micro-metastatic disease too small to be seen by imaging. So, back on triplet therapy for a defined period.
I will say that the side affects from Relugolix early on have been much less than the same point when I was on Lupron. It's early in the treatment though...
Based on your clinical data, may be to soon to pull the trigger and treat.
With some adverse pathology in my pathology report (T3a) following surgery in Dec. 2018, but fortunately PSA below the limit of detection (<0.014 ng/ml) since then, if PSA becomes detectable, I plan to make a list of the best candidates for radiation oncologists and radiation treatment facilities; and also initiate genomic testing of tumor samples, so as to be in position to finalize treatment plans pull the trigger on salvage radiation treatment upon PSA increasing to 0.1-0.2 ng/ml. I wouldn't want to have to rush through the selection process.
Best wishes for successful treatment and a good outcome!
I am different than most. I say hit the bastard hard and early with all the tools available including systemic treatment like adjunctive chemotherapy. Get the opinion from your medical specialists on micro-metastasis and treatment. Why wait for our cancer to rear it’s ugly head down the road?
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