Limbo period after BCR post RP and SRT and prior to PSA enough for PSMA PET?

[bldn10]

Quick background: RP 2/02, Meyers' PSA suppression until 2016 when PSA jumped from 17 to 28 in a month, 6 mos. adjuvant ADT3 before, during, after SRT, undetectable PSA until 5/30/23 at .1; .14 6/6; .12 7/11; .17 9/5.

I have talked to a uro friend and seen my rad-onc and the plan seems to be to wait until PSA .3-.5 for PSMA scan. The rad-onc scheduled me for the next PSA in 6 mos. It seems odd to just sit and let the disease run when perhaps there are some things I could do to slow the progression, like Avodart. OTOH I clearly have BCR so is it better in the long run to get to the scan/definitive Tx sooner than later? Or 3rd option - hit it hard w/ ADT3 now? If I have a chance of prolonged remission via SRT2 I don't want to lose it.

Bill/Memphis

[Tall_Allen]

What was irradiated during your SRT - prostate bed? Pelvic Lymph nodes?

Your PSA is still too low and slow to do anything. Even if it increases to 0.5 or gets more rapid, a PSMA PET may or may not show anything. If it doesn't, a short course of hormone therapy may be beneficial:

prostatecancer.news/2022/09...

prostatecancer.news/2023/05...

[bldn10 in reply to Tall_Allen]

In 2015 I had a C11 Choline PET and it showed 2 spots in the bed, which was irradiated w/ boost to the spots. Almost 7 years undetectable PSA.

Interesting that in the most recent trial you linked to it was stated that if they started all over today, everyone would get a PSMA.

[Tall_Allen in reply to bldn10]

Yes, The EMBARK protocol only allowed men who had PSA≥ 1 ng/ml and PSA doubling time (PSADT) ≤ 9 months. The PRESTO trial only allowed men who had PSA>0.5 ng/ml and PSA doubling time (PSADT) ≤ 9 month. So both trials would begin with PSMA PET if started today.

If the recurrence is in your pelvic lymph node area, there is a second chance at a cure, if the entire area is irradiated. But you have to wait for PSA> 0.5. I usually am not a fan of waiting, but in your case, there is little risk because your cancer has been so slow.

[ron_bucher in reply to Tall_Allen]

Every case is unique. I had prophylactic radiation on lymph nodes outside the local area plus Taxotere when my PSA doubled within 6 months to 0.06. It was all covered by Medicare. It gave me 4 years or so of undetectable PSA without ADT which I consider good success.

[Explorer08]

My PSA hit 0.72 recently so last week I had a PSMA PET Scan. One lower left pelvic lymph node lit up like a light bulb so I restart Orgovyx tomorrow morning. I am meeting with a rad onc this coming Monday to get a consult on possible next steps regarding hitting that one lymph node with stereotactic radiation. (My RRP was 12 years ago and I did Orgovyx from March 2021 through April 2022.). I have an out of state friend who is in the same boat as me and his rad onc said that once lymph node involvement is discovered then the patient will playing "whack a mole" for the rest of his life - - a pretty apt description, I thought.

[Hawk56]

Here's my clinical history.

On this go around, my medical team and I had decision criteria about imaging, three or more consecutive increases, spaced 2-3 months apart, PSA >.5.

This year that decision criteria was met, we imaged with PLarify, it showed one PLN. We decided initially on SBRT to that PLN, 5 x 80GYa and six months Orgovyx to address any micro-metastatic disease.

Oncologist is holding off on an ARI, Xtandi, since PSA undetectable at <.04 and T castrate at <9. Next decision point is in late October, the six month point. Both oncologist and radiologist leaning towards 12 months ADT.

I sent him a message about the ARCHES trial - urotoday.com/recent-abstrac... saying I wanted to discuss it in relation to any treatment decision we make in October.

My medical team and I did not see any risk in waiting for PSA to climb to .5 or greater.

Kevin

Clinical History

[j-o-h-n]

Doctors are:

like buying pizza from different pizza restaurants........Some are worth going back to in the future.....Some you wouldn't even use their pizza to replace the soles of your shoes....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/08/2023 4:45 PM DST

[bldn10]

Saw an MO yesterday and he had a different take on the PSMA scan for my presentation [post RP and SRT]. He basically implied that irradiating a few mets would not likely be curative so why bother - just go straight to ADT. He said he had several Pts who had been only on Lupron for like 20 years, and that my PCa seemed rather tame and that Tx would probably work for me until I die of something else. He would get the PSMA just to make sure I did not have extensive disease.

[bldn10 in reply to bldn10]

LOL After calling twice this morning to get my PSA, a young lady called and cheerfully informed me that "Everything looks good; your PSA was normal at .22." Definitely not going back there.