PSA Rising After PBRT

[FLRichardson]

Underwent prostate bed radiation in 2022 with good results — about a year of PSA at .02 to .05 — past six months, .09 and now at .17

Will get a PSMA-PET, but am curious what’s next ??

[Tall_Allen]

Possibly radiation to pelvic lymph node area.

[Still_in_shock in reply to Tall_Allen]

ADT too.

[FLRichardson in reply to Tall_Allen]

Thanks. You have always been helpful! I was on Eligard during my PBRT, so I guess I "get" to look forward to that again...

[FjSENC in reply to FLRichardson]

Yay. Jk. I think I will be enjoying Eligard again soon.

[God_Loves_Me]

Immediate coordinate with doctor and may be he prescribe you "bicalutamide".

[RyderLake2]

Hello,

If you have not yet been on an Androgen Receptor Pathway Inhibitor (ARPI) drug like Xtandi or Zytiga that may be next. If you have, then your oncologist might want to prescribe a cytotoxic drug, something that kills prostate cancer cells rather than just suppressing them or putting them to sleep. Examples are chemotherapy or a radio pharmaceutical like Lutetium 177. Good luck!

[FLRichardson in reply to RyderLake2]

Thanks. All of this is good to learn.

[vintage42 in reply to RyderLake2]

You said: "If you have not yet been on ... (ARPI) drug like Xtandi or Zytiga that may be next. If you have, then your oncologist might want to prescribe a cytotoxic drug... chemotherapy... that kills prostate cancer cells rather than just suppressing them or putting them to sleep."

My understanding is chemo must come first, is not effective after the other drugs suppress the cells.

[RyderLake2 in reply to vintage42]

Hello,

I certainly aware of chemotherapy being one part of triplet therapy but I unaware of chemotherapy being prescribed as a monotherapy before ADT or ARPI drugs.

[vintage42 in reply to RyderLake2]

Maybe not first, but at the same time, not after.

"You can't do chemo after Zytiga helps. You have to start them at around the same time (called "triplet therapy"). The reason is that cancer cells that are not killed by Zytiga go into an impervious state called senescence. Chemo only kills rapidly duplicating cells." -Tall_Allen in HealthUnlocked: healthunlocked.com/advanced...

Here is a reference to chemo mono therapy: "Docetaxel monotherapy is the approved treatment for patients with metastatic CRPC..." pubmed.ncbi.nlm.nih.gov/186...

[NanoMRI]

What's next? Depends on your objective. I did not want ADT/CR/chemo so I went for better imaging and based on that imaging went for salvage extended pelvic lymph node surgery, at 0.11. Six years later and doing very well. I would consider mpMRI combined with PSMA and/or fluciclovine for comparison and blood biopsy and genetic testing as your previous post suggest possible lung met. All the best!

[FLRichardson in reply to NanoMRI]

Thanks. I'm pursuing imaging and appreciate all of the ideas.

[Leaffan57]

radiation to the spread, followed by ADT and apalutimide.

[vintage42]

So the rising PSA might come from mets. Mine did -- a PSMA-PET scan found cancer remaining in the prostate and spread to a pelvic node. So I had IMRT to the whole pelvis with focus on the one node, and then belatedly started ADT with Orgovyx and Abiraterone (aka Zytiga) with Prednisone.

No side effects to speak of from prostate and pelvic IMRT in 2021 and 2023, nor from the ADT started in 2023.

[_knowledgeiskey00 in reply to vintage42]

what ADT are u on?

[vintage42 in reply to _knowledgeiskey00]

Orgovyx, and Abiraterone (Zytiga) with Prednisone.

[RoseDoc]

It all depends upon the result of your PSMA scan. If there is a pelvic lymph node it can be cryo ablated. If more than one you might consider a lymph node dissection.

Otherwise, if there is a distant met, good chance of triplet therapy- ADT plus Docetaxel. Good luck with the scan!