PSA Doubled in 2 Months

[NJWarrior]

PSA end of August was 0.12 now 0.24. I met with 2 ROs to discuss treatment when my PSA was 0.20 a week ago . One suggested ADT 18-24 months and prostate bed radiation. Second RO says we can avoid ADT for now as he sees 0.70 as the value he believes requires ADT. I'm scheduled for F18 PSMA scan in early December and pelvic MRI the end of December which may change the treatment planning. I'm concerned about PSA rising quickly, at least in my mind. Is a doubling at these low numbers something I should be moving faster to treat?

[MoonRocket]

If you want the best chance for a meaningful PSMA scan, wait until the PSA reaches 1. After the PSMA scan results are returned, if nothing else, the newly released EMBARK trial and FDA approved use of xtandi in the BCR setting is your best treatment option.

[NJWarrior in reply to MoonRocket]

Thank you.

[London441 in reply to MoonRocket]

Not unless he's given up on cure.

[MoonRocket in reply to London441]

It's why I wrote "if nothing else"...if the PSMA scan yields nothing, then he can follow the newly approved EMBARK trial. Otherwise, he can do WPRT and hope for a cure but there are no guarantees as many on this board know first hand.

[London441 in reply to MoonRocket]

It's really quite simple. He clearly needs more treatment sooner or later. But with that kind of PSADT, later is a palpable risk.

If he goes for a cure now and it doesn't work, he's on essentially the same path minus the radiation. No great loss. If he keeps waiting he loses his shot. Big loss.

[MoonRocket in reply to London441]

That's hypothetical. My comment was specifically directed to getting the PSMA scan.. nothing else. If he wants SRT, he doesn't need a PSMA scan..just get the SRT. But if the intent is to actually locate the metastases then waiting until 1 will provide a better opportunity to do so. At his rate of PSADT, it's not that long.

[London441 in reply to MoonRocket]

Sure. It's just a matter of whether 'actually locating the metastases' is worth the risk of letting the disease progress.

I can't identify with that.

[MoonRocket in reply to London441]

Neither could I but if he's spending money to get a PSMA scan, I'd want to increase the odds of finding something. I know first hand since my PSMA scan at .7 found zilch.

[London441 in reply to MoonRocket]

Money! 5 years ago it was thousands, in the the US anyway, plus the travel to the few places that had it. Not much before that it didn't exist. My treatment path would have been quite different if it did. Screw the money.

[MoonRocket in reply to London441]

That's why you're Mr. Wonderful and feel obligated to respond to anyone who has a different opinion. Not everyone on this site can disregard the co pay. Especially for a test that is at most 60% at find anything when PSA is < .8

Less you forget already, you replied to my original comment.

[London441 in reply to MoonRocket]

Well that's enough of all that. Happy Thanksgiving to you!

[Tall_Allen]

This is something to get taken care of right away. I agree that the doubling time is troubling.

I disagree about only using ADT if PSA reaches 0.7. If you want the salvage radiation to be curative, you should use 4-6 months of ADT.

"In contrast to a previous trial (RTOG 9601) that told us that ADT can be safely avoided if PSA<0.7, this trial suggests at least 4 months of ADT and whole pelvic treatment. The reason for the difference in recommendations is due to the choice of endpoint. SPPORT is telling us that if we are willing to put up with 4 months of ADT and some extra short-term toxicity from the wider field of radiation, a cure is likely. RTOG 9601 tells us that if your PSA<0.7, you aren't likely to die if you don't get the extra short-term hormone therapy, but you may have to have lifelong ADT eventually. It will always be a managed disease. Patients should acknowledge these trade-offs and discuss with their doctors."

prostatecancer.news/2022/05...

Now, SPPORT sets the bar at a PSA of 0.35. However, your PSA is already 0.24 and doubling quickly. By the time you have salvage radiation, it may well have exceeded 0.35. It should also be noted that there is no inflection point at 0.35 (patients with PSAs of 0.4 did not respond markedly differently than patients with a PSA of 0.3) - it is just an arbitrary point in the middle of the patients in that trial. You should consider other factors like your PSADT and pathology report.

Waiting for imaging is problematic. A couple of weeks for the PSMA PET scan should be no problem though. Waiting longer to find metastases may be a self-fulfilling prophecy. If the MRI at the end of December is for radiation planning, you can start on ADT (if you decide to use it) right after the PET scan.

There is a new PET indicator called "Posluma" which is more sensitive for recurrences in the prostate bed, if it is available in your area.

posluma.com/availability

[Don_1213 in reply to Tall_Allen]

TA, that's a MUCH better plan then he's gotten from either RO.. I think he might also benefit from talking to a good medical oncologist. If you check his bio - the PSA has been increasing steadily for some time so we know something is going on somewhere. The PSMA-PET scan should be revealing.

[Tall_Allen in reply to Don_1213]

I'm not a big fan of bringing in more doctors if they are not needed. Medical Oncologists are primary if the cancer is not curable. Because their field is treating with medicines, that is their bias, and they know little about salvage therapies. I've found that many doctors (the better ones) love to discuss issues like those above, and are very compliant with patient wishes if approached right. They usually prefer shared decision making to paternalistic dictating - I've found it is often patients who force their doctors into a paternalistic role. (hint: never ask "what would you do if you were me/I were your father.")

[NJWarrior]

I essentially have no valuable pathology from the surgery since I took 3 months of ADT prior to the surgery. No lymph nodes were positive, clean margins but tumor staging wasn't done because of the effects of the ADT.

I've reached out to both oncologists I met with asking about the Posluma tracer.

I appreciate your response.

[RMontana]

PSADT (doubling time) and PSA density are both things you should track, understand and act on...check this article which I posted some time back...I did not act in time, thought PSA of 4.0 was "safe," and the rest is history...dont let this disease get outside your prostate! If you act sooner rather than too late the outcomes can be really good...

healthunlocked.com/active-s...

Listen to this podcast as well on PSADT...

healthunlocked.com/active-s...

...time is NOT on your side with this disease IF you have it. A pMRI could (should) tell you if a tumor is present and if you find a tumor kill it as fast, as small and as soon as you can. Rick