Slowly Rising PSA - Getting Nervous

[raisin123]

It seems in the last 4 months it has been rising more. Doctors are waiting until in gets to the standard 0.2 before starting radiation. I do understand why they need to wait as the PSA isn't high enough yet for the risk/reward of treatment.

03/17/2023 0.029

04/22/2023 0.032

08/23/2023 0.046

12/07/2023 0.082

History

PSA of 20 in April 2022

Bone Scan Negative April 2022

CT Pelvis/Abs Negative July 2022

Biopsy Gleason 7(4x3) 8 of 12 cores. July 2022

RALP September 2022

Pathology Report Sept 2022- Gleason 9(4x5), Grade 5, Stage pT3b (Seminal vesicle invasion) , Positive margins 3mm, Lymphovascular Invasion,Extraprostatic Extension

[6357axbz]

could be they are waiting till PSA is sufficiently high to get a good psma scan to positively identify any mets

[Tall_Allen]

They are blindly following the results of this:

prostatecancer.news/2019/09...

BUT, those trials had inadequate samples of men with high risk pathology like you. Subsequent studies suggest that for men with Gleason 9 and stage T3, there is an advantage in doing salvage radiation ASAP. Maybe email them the following and then meet with them to discuss:

ascopubs.org/doi/full/10.12...

[raisin123 in reply to Tall_Allen]

I have an appointment at the end of January I will bring that up to him then. thanks

[Tall_Allen in reply to raisin123]

I suggest emailing the link to him before the meeting. Surprising a doctor with new data at a meeting is never a good idea.

[Justfor_]

Almost same pathology and course here. Instead of following up with blind sRT, I elected gaining some time with adaptive Bicalutamide dosing. Just passed successfully the 2 year mark. Will see for how long it will go on working. Documenting my doings month by month in a thread entitled: "An engineer's Bicalutamide maneuvers".

[London441]

I also had as close to same pathology as you that I’ve seen, except undetectable PSA post op and 4+3 held up.

However, I did have several saturated cores with 80% pattern 4.

I chose a very aggressive clinical trial of whole pelvic RT, abiraterone and 18 months ADT. I remain undetectable and drug free since the RALP in June of ‘19.

I wasn’t too enthusiastic about the ADT, no one is. But I knew what I needed to do to handle it well and did pretty easily.

I really like being drug free and having full return of testosterone for over 2 1/2 years now. We’ll see if it lasts, but I am prepared to the best of my ability to accept wherever I’m taken. .

PSMA scans weren’t available to me back then, they are to your advantage now. I would choose a different treatment path today if I had to do it all again but if I were you I would likely still try to nail it early. You have some seriously adverse features there, as did I.

Great luck to you!

[raisin123 in reply to London441]

thanks I am doing another test around January 20th and then my radiologist appointment on the 22nd. If it continues to rise I will try to talk them into early treatment.

[London441 in reply to raisin123]

You don’t have to ‘try to talk them into’ anything. You are piloting the aircraft.

[raisin123]

Not sure about other areas but here they have protocols they have to adhere too. I’m just glad to have some doctors I can go to. You can wait up to 7 months to see doctors here.

[RMontana]

I have two articles that may be of interest;

First, PSADT doubling time has to be considered; yours is shorter than 15 months. Use this to your advantage to predict what's coming and act sooner than later.

healthunlocked.com/active-s...

Next, the percent of GS 4/5 in your biopsy matters...you dont state it but take a look at these predictive values...

healthunlocked.com/active-s...

Good luck. If I could go back I would have acted sooner and prevented this disease from progressing outside my prostate...that is key to a good outcome. Get the facts and act as soon as you think you need to. Rick

[fast_eddie]

Despite a clean PET scan my PSA has been slowly rising too. I haven't been on ADT meds for six years. My urologist decided to put me on what I call 'ADT lite' -- finisteride. We'll see how that is working when I get my next PSA test in January.

"Finasteride, a specific and competitive inhibitor of 5α-reductase enzyme Type 2, inhibits the conversion of testosterone to dihydrotestosterone (DHT). In adults, DHT acts as primary androgen in prostate ..."

ncbi.nlm.nih.gov/pmc/articl....