PSA on the rise

[Geno2853]

Stage 3 prostate cancer. Radical prostatectomy and radiation in 2013. PSA has gone from 0 to 0.41. What’s likely to happen?  Thanks. 

[Spyder54]

I wouldnt hesitate. Get a Pylarify PSMA PET Scan. If you are on the West Coast, get a Gal68;PSMA PET Scan (only a few offer). These scans are much more sensitive than a CT or MRI. Assuming you are PSMA Avid, it will show you where the recurrence is located, and then you can make an educated decision on the smartest course of action. Best of luck, Mike

[Tall_Allen in reply to Spyder54]

"you can make an educated decision on the smartest course of action. " what course of action would it help him decide about?

[Spyder54 in reply to Tall_Allen]

the Scan should give direction. No sense in guessing.

[Tall_Allen in reply to Spyder54]

Guessing about what exactly?

[Spyder54 in reply to Tall_Allen]

?? TA, you know as well as anyone on this site the multitude of surprises a PSMA PET can show us. And you know the multitude of choices of medical disciplines that may be appropriate.

This is exactly my point. Why would anyone guess. Once you see what is happening, only then can you make a decision of what action a Man can take to extend life.

Not sure what you are getting at? In the 31 months since my Dx in October of ‘20, the choices are increasing, not decreasing. Mike

[Tall_Allen in reply to Spyder54]

Your inability to answer my very simple question should show you that you have no idea what that test is for. I know you are trying to be helpful, but I hope that question is one you will ask yourself before you try to give bad advice to others.

[Spyder54 in reply to Tall_Allen]

Reluctance. Not inability. We dont know for sure what is causing the PSA rise until we see the scan. My entire point repeated 3x. If it is in bone it is one approach. If it in lymph nodes another, soft tissue another. Organs, another. Brain, another.

Not until you see what you’re dealing with, from the PSMA PET can you make an educated decision. Back where I started 4 days ago. You being very stubborn here for some strange reason.

Look below TA Read what Howard53545 experienced. Look below what Hawk56 experienced. Read what Manila experienced below. Real Life. Exactly what I have been saying.

Now please drop this sillyness. I have been too kind and respectful of you, and your knowledge. You have asked me the same question 3x. Its obnoxious. This not a game. I have Stage 4 Metastatic Prostate Cancer. My patience runs thin. Mike

[Tall_Allen in reply to Spyder54]

The OP has a PSA of 0.41, but the doubling time is very slow- one year. We know from many years of experience that prostate cancer moves from the prostate into the prostate bed, and from there into the pelvic lymph nodes or bone. PSMA PET scans have only 40% sensitivity for detecting cancer in pelvic lymph nodes. From questions I asked him, I determined that he has had prostate bed radiation, but can still have salvage radiation to the entire pelvic LN area. You didn't even ask.

After his answers, I now agree with you that a PSMA PET scan should be done, and it is likely that his RO will order one. It will rule out bone metastases. But even if it is negative, he should go ahead with the salvage radiation to the entire pelvic LN area. "Seeing what one is dealing with" is not helpful in that case -- one has to treat whether it is seen or not - 60% of the time it will not be seen.

I've seen too many patients who take flippant advice like you were giving and decided not to have salvage radiation to the entire pelvic LN area. Others may find just one or two light up and only treat those. Either strategy is disastrous. Your advice is based on over-reliance on what is a very insensitive scan.

[Tall_Allen]

What is your PSADT in the last year?

[Geno2853 in reply to Tall_Allen]

last year went up to .21

[Tall_Allen in reply to Geno2853]

So it is very slowly doubling. And when you had the salvage radiation, what is the area that was treated?

[Geno2853 in reply to Tall_Allen]

area surrounding prostate location

[Tall_Allen in reply to Geno2853]

Then there is still an opportunity to have curative radiation in the pelvic lymph nodes. Talk to a radiation oncologist.

[Howard53545]

Our history is the same. I had salvage radiation after surgery because of PSA rise, then had a PSMA scan which show that a lymph node was positive so we radiated entire pelvic area followed by 2 years of lupron and since PSA has been undetectable.

[Hawk56]

As others have said, it may be useful to have a PSMA scan to inform your decision. That decision is likely already "made", doublet or triplet therapy. Likely radiation to the entire PLN system with the addition of one or two ADT agents, an anti-androgen and possible an androgen receptor inhibitor. The duration may be 2-3 years with as TA says either an elusive cure for advanced PCa or a long term progression free period where no treatment, only active monitoring. The PSMA scan may give you clinical data in the number and location of the sites where the PCa is, keeping in mind micro metastatic disease too small too be seen by imaging. If it does, your radiologist can factor those into the treatment plan.

Kevin

[Geno2853 in reply to Hawk56]

Great.

[j-o-h-n]

Hey Gino help us and help yourself by updating your bio..... It's all voluntary (and it doesn't hurt.) Thanks and keep posting here. Age, location, meds, treatment center(s) and doctor's name help but all voluntary, THANKS!!!

BTW if you don 't update I will go to your house and bore you to death.....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/13/2023 7:11 PM DST

[Manilo]

My PSA went from 0.05 to 0.25 and I did PET CT PSMA. Several cancer spots in prostate, lymph nodes and bones were visible.Did a single Lu177 cycle. And for a few months (4) PSA was stable at 0.24-0.30

9 months later PSA begun rising again but PET CT PSMA showed cancer only in a rib.

Did SBRT to the rib with PSA 8.5 one year after the Lu177.

9 months after the SBRT, PSA is now 1.17.

Watching for PSA falling (hopefully to zero). Or else, will check with PET CT PSMA and also FDG and then decide if I do more SBRT, BAT, or whatever.

I am mCRPC but doing ADT only, without yet using Enza, Abi,...

I am not fully following the protocols.

I do intermittent fasting often. And once or twice per month I don't eat at all during 48 hours.

I eat 90% vegan (without potatoes, rice, bread, wheat. No alcohol either.)

I try to go to the gym as much as possible, and walk 5 km daily. Keep lean at 75Kg, being 1.78 tall.

I take a teaspoon of inuline powder through the day.

Also take NAC.

And some cycles of iP6 when I do 48h fasting, that I only drink water with iP6 those 2 days.

AND I take DUKORAL every month or two.

[RMontana]

First, PSA doubling time matters; see this podcast on PSADT...

healthunlocked.com/active-s...

...but you need to know which PSA values to use when calculating it! You cant use PSA values if TET (testosterone) levels are moving up or down. Check out Min 15:45 in the following podcast (and see what other things you can pull out of the case histories).

healthunlocked.com/active-s...

Next, you can slow down PSA increases with Sulforaphane...

healthunlocked.com/active-s...

healthunlocked.com/active-s...

...I use the following supplements, just in case you are interested.

healthunlocked.com/active-s...

Last, even Vitamin D3 helps. See this podcast.

healthunlocked.com/active-s...

So, PSA alone wont help. You need Genomic and may need Germline Testing as well, to help you make the best decisions...there are no guarantees, but the legitimate medical testing that is done and documented can help us make the best call we can for our individual case histories...good luck. Rick

[Justfor_]

I document my self designed plan monthly in my thread titled: "An engineer's Bicalutamide maneuvers". Medical salesmen and their parrots won't endorse it as there is no serious money involved in it.