after being undetectable for ~ 5 years my PSA became detectable 0.10 in July. In October I was retested and my PSA was 0.30 . In early November I had a PSMA-Pet scan which was negative. Today I was retested with a result of 0.40. How soon should I followup with my MO? Any advice would be appreciated
Thanks
Get moving on a PSMA scan while you wait for your appt. Most MOs will work with you to get the tests done before a visit. Start looking at the EMBARK Trial. ADT + Xtandi for BCR patients.
MoonRocket, thank you for the feedback and suggestions. I will look up the EMBARK trial. My MO is at Dana Farber, waiting for him to get back to me
PSA 2.0 or doubling time< 9 months.
Hi Tall_Allen,
So if my PSA goes from 0.40 to 0.80 in less than 9 months or reaches 2.0 only then should I consider treatment? When should I consider another PSMA scan.
Thanks for the feedback, greatly appreciated
When you had SRT, did they do lymph nodes, or just prostate bed?
my lymph nodes were removed during RP, pathology came back negative. I did have perineural invasion
Not sure about SRT to the lymph node area
There is nothing worth doing until at least one of those is reached, so I can't see how you would use the PSMA PET.
Got it, thanks
Isn't his PSADT, from 0.1 to 0.4 in five months, far under 9 months?
But his PSA has not yet reached 1.0 as in EMBARK. PSADT is only calculable after 3 values above 0.1
Do you mean three values above 1.0?
no, above 0.1
OP has no prostate, and has had SRT, 2.0 doesnt apply
0.2 is BCR, with 3 month doubling, no?
You are correct...some don't read before replying
Sorry. I don't understand what you are driving at.
OP has no prostate.
Waiting for 2.0 doesn’t apply to him.
0.2 is BCR in his case.
Not having a prostate, waiting for 2.0 is not good.
IDK why you believe that. There is no standard definition for a second BCR.
prostatecancer.news/2019/08...
There are no therapies worth doing for recurrent patients until PSA reaches at least 1.0 with rapid PSADT, or 2.0 without rapid PSADT.
Thanks for the review
As I am reading the rules as outlined for a person with no prostate, I am wondering if this would apply to me as well. I went thru RT and still have my prostate. Would this psa2.0 rule apply to me also. If not what might be the difference in the parameters? i seem to be fairly steady at 1.4
PSA DOUBLING TIME
Months
Doubling Time 2.5 months
Slope Log (PSA) 0.3
Velocity 0.1 ng/mL/mo
Years
Doubling Time 0.2 years
Slope Log (PSA) 3.4
Velocity 0.7 ng/mL/yr
based on my Information
PSA Date PSA Value
07/15/2023 0.1 ng/ml
10/15/2023 0.30 ng/ml
12/15/2023 0.40 ng/ml
Scans may not show microscopic metastases for years. Watch for lymph node swellings, pain from small tumor growth. Review ADT options (intermittant, continuous, Lupron, Orgovyx, etcetera, with oncologist. Consider dietary changes, e.g. reduce red meat, dairy, increase lycopene intake, study alternative medicines and foods.
I haven’t had a prostate for 10 years. My PSA has risen to 0.51 (0.4 this week from my family practitioner). I consult with 2 urologists. Both concur to wait til 2.0 before ADT. Both concur that a scan at this point would not show anything. Both concur that while starting ADT now would drive my PSA to zero, the data does not show that it would extend my life. Both concur that I would not like the side effects of ADT.
Does your medical oncologist concur with your urologists? Salvage radiation a year after my prostatectomy (without any ADT) gave me 7.5 years of undetectable PSA.
Based on everything I've learned, waiting without treatment carries its own risk for advancing prostate cancer.
Your PSA trajectory clearly suggests your cancer is advancing. Nobody knows if or when its advance will accelerate. The more time you give it, the more chance it has to grow and mutate.
Your medical oncologist will probably suggest several treatment options depending on your ongoing test results. Urologists are generally not current on all the options.
when that happened to me I saw an MO who added Xgeva to my estradiol patches. Back to undetectable since 2021.
now.
These two publications could interest you. It appears you may be headed for salvage (radiation (sRT). I had salvage immediately following my RP as my PSA was recurrent; never dropped after surgery.
First, PSADT is more important than PSA and your DT is less than 15 months. Check this out as to when to move to scanning n treatment. You are headed in the direction where MET (metastasis) can be found via PSMA PET and this article says not to wait for PSA of 2.0 (Phoenix Threshold) as you can be positive below that level. See; Min 5:39; at what PSA level should a PSMA PET be done. Detection rates for PSA values listed. I would not wait for PSA to rise to 2.0 to be 100% sure of finding it; find it sooner and get treated faster for better outcomes (that is what I would do).
healthunlocked.com/active-s...
Next, if you receive sRT you will must likely be given a choice about ADT treatment. This study shows the value of long term vs short term ADT treatment following sRT. As an a(distant MET). If you have good sexual function and value that aspect of your life understand what long term ADT will do. Doctor's wont necessarily tell you these details. I wont go into them here; check out my many posts at my site.
healthunlocked.com/active-s...
Good luck. Rick
I had SRT ~ 2 years after RP, and had a PSMA in early Nov which was negative.
I appreciate your feedback
6 years after RP my previously undetectable PSA had slowly risen to 0.2. PSMA Pet scan found nothing definite. Over a 12 month period I had a total of 5 PSMA scans including one with a new isotope. All inconclusive. PSA was 0.33 at time of 5th PSMA
It is now 14 months since last scan and PSA is now 0.44 with a noticeable slowing in rate of increase. Current plan is to wait until I hit 0.6 before next PSMA
I am 65 and now more than 8 years post RP .
My point here is that when PSA is low but greater than 0.2, the scan may not show anything
Granted, but there is suggestion and medical practice that says wait for a PSA of 2.0 BEFORE you start scanning! I think that is waiting too long. I would have done the same as you and try to find this thing as early as possible, at the lowest PSA possible...treat it as soon as you can. I think you are doing the right thing. Check out my references on the odds of POS scans at different levels and they are NOT zero below PSA of 2.0...Rick
No mention of why you had radiation in 2021. Was it IMRT or SBRT. Could it have been proton.
(SRT is Stereotactic radiation to the BRAIN) SBRT (Stereotactic body radiation is Stereotactic radiation to areas other than the brain)
Non detectable is a vague term with no precise meaning. It does not mean you can't detect cancer, using ultrasenitive PSA tests allows you to see PSA rising well before what I call the old fashion PSA test that only detects to 0.1
You need to know what areas received radiation. Was it just the pelvic bed or Whole pelvic.
Did PSA change after radiation. Did you use a ultrasenitive PSA test like LabCorp which detects to 0.006
6 weeks After RP a PSA of 0.03 or greater means you are likely to have reoccurrence. A PSA of 0.02 or less means it's unlikely you will have reoccurrence.
Having negative lymph nodes at RP means only those lymph nodes were negative. There can be other lymph nodes or the lymph system that has PC.
Have you been on any ADT lupron etc.
PSMA scans detect based on various factors, how rapid the PSA rises, how many places is the PC, a single spot will be detected at a lower PSA than PC that's in more places.
You certainly can detect at 2.0 or less if you have a single or few spots contributing to your PSA rise. And/or your PSA is rising with some vigor.
Insurance may "require" a PSA of 1.0 or greater in some instances.
Interestingly I see several different doctors and hospitals. I have had 2 PSMA scans in the past 6 months ( needed to be 3 months apart) and will be going back for a post SBRT PSMA scan in February.
The interesting thing was my hospital in central Florida said they were impressed that I had had 2 recent PSMA scans. They said their patients get denied for the scan and have performed few of them.
I took that to means that because in that area only HMO are offered under the ACA and advantage plans are the majority as well.
That denial of care is the price for having these plans instead of PPO and real Medicare.
Be careful of your insurance selections.
yes, I would be concerned. Although your numbers are low the doubling time seems high. Have they performed salvage radiation? They did this for me when my PSA was .3. This is where they radiate the prostate bed. It did not have an effect on my numbers. My doctor also put me on ultra sensitive PSA tests. My first pet scan was with auxin which failed to find anything. My second was with PSMA which located 2 times in my lymph nodes. I was given 5 session of radiation, which apparently had no effect, already no change in 3 months after radiation then it did go down a little. My situation is different than yours in that in 2018 my PSA was .3 and it is now .68.
Being our situations are different I won’t give you advice on which treatment to take or not to take. I do believe diet, exercise and mental health ( little stress) has an effect on the numbers.
Best
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