psa rising

[Howard53545]

After a second rise in psa from .04 to .21 in three months we decided to meet with a medical oncologist to discuss next steps. I am inclined to get a scan to locate pc but it may be too low. I have had surgery followed by salvage radiation followed by a scan and pelvic radiation so I may have exhausted radiation. Any thoughts?

[GP24]

After surgery you had to get salvage radiation when the PSA value got above 0.2 ng/ml. Now that you already had salvage radiation you do not have to act at the 0.2 ng/ml value. You can wait until the PSA value gets avove 2.0 ng/ml and do a scan then. I assume the MO will recommend to start with hormone therapy but as long as you are not afraid of the PSA value you do not need to start with it before the scan.

[NanoMRI]

After my RP (eight years ago) and salvage RT to prostate bed (seven years ago), at usPSA 0.13 I had successful imaging, Ferrtoran nanoparticle MRI, followed by salvage extended pelvic lymph node dissection surgery (six years ago). The ePLND resulted in usPSA <0.010; which held for first two years. After loss of < slow incremental rise to 0.03X – which has held last two years. All the best!

[Tall_Allen]

If you had whole pelvic radiation already, you cannot repeat that. If your PSA reaches 1.0 with a doubling time of <9 months, consider The EMBARK or PRESTO protocol:

prostatecancer.news/2023/05...

prostatecancer.news/2022/09...

At that point, a PSMA PET may or may not show any of your larger metastases, and you can have them zapped if safe (but no one knows if it does any good).

[Justfor_]

With your PSADT of less than 1.5 months your probability for a PSMA PET scan positive detection (off the top of my head) can be 30% to 50%. I would had gone for it before the initial blind sRT, instead of the second -as you did- yet, it is never too late to try to get some better visibility.

[Sparrow47]

I am in a somewhat similar situation. My PSA was undetectable for 7+ years after surgical removal, then went to .1. I have an appointment with an oncologist today, so will learn more. I understand that scans are effective at .2, so it may be time for you.

[Hawk56]

I wouldn't say you exhausted radiation. I had SRT and WPLN, when my PCa came back again and the Plarify scan showed a single PLN, my radiologist was able to use SBRT to it think time since previous radiation and location are factors.

I had decision criteria about imaging, three consecutive increases in PSA spaced 2-4 months apart and PSA between .5-1.0 to have a better chance of the scan locating the Pca., it did. My PSADT is also very rapid, so that was a factor.

The key as others have mentioned is how to deal with systemic disease, ADT, ADT +ARI, Chemotherapy, ARI only, other...lots of options there, both in which agent and duration.

I've attached my clinical history.

This go around based on my clinical history and the Plarify scan, we decided on SBRT and 12 months Orgovyx the ARI was held in reserve if Orgovyx didn't drop T and PSA o undetectable within the first three months, it did.

I meet with oncologist on 4 April after labs on 2 April, if no change, plan to stop treatment and actively monitor, when it comes back, repeat...scan, decide, treat, monitor, have criteria to stop or continue.

Kevin, study of one...

Clinical History