Please advise about treatment

[Simonapo]

I posted recently about my Dad’s PSA going up from 0.008 in December 2023 to 0.029 in March 2024. He had a PET Scan that showed some activity in a rib and prostate, MRI showed nothing. The PSA started dropping to 0.026 at the end of March and then 0.025 in April without any treatment. We didn’t anticipate PSA to drop on it’s own and we already had scheduled 3 SBRT to the rib at UCLA with Dr Kishan so we moved forward with SBRT to the rib. 3 weeks later PSA dropped to 0.015. What should we do next? Do we need a biopsy of the prostate? Do we need any treatment of the prostate? My Dad already had 6 weeks of radiation for prostate back in 2021, Dr Kishan said he can’t do anymore SBRT to prostate. Please let me know your opinion. As always thank you so much for all your help over the years.

[Radtech40]

Our oncologist told us to use SBRT only when needed since you can only do it once to that area, treating the prostate since it has spread is done by hormone therapy, chemo, etc. that will help control the cancer cells as long as the body responds. Dad had activity in the hip and they radiated that years ago and it bought a year without treatment, then psa started rising so they started xtandi.

[Simonapo in reply to Radtech40]

Thank you so much Helen❤️

[Kaliber]

I’m with Kaiser, Kaiser only measures PSA down to <0.1 . If you were with Kaiser you wouldn’t even know about those extremely low changes and wouldn’t be concerned with them at all. Kaiser looks at both psa and doubling time as main factors in making diagnostic - treatment decisions. All of my oncologist ( 5 so far ) don’t care about micro changes in PSA , and only consider changes in treatment when the total PSA has climbed to 2.0 or higher . How quickly it got there might draw their attention, if it was a rapid change.

This is just how Kaiser does things, obviously your doctors do it differently. Kaiser’s methods have given me nearly 6 years ( and counting. ) of unexpected life extension. No complaints about longevity, not saying much for the quality of my life in that time period tho. lol

Hope your dad continues to have such wonderful PSA levels and keeps on keeping on. I’d be thrilled with those numbers myself.

❤️❤️❤️

[Still_in_shock in reply to Kaliber]

To expound, treatment at 0.2 if prostate has been removed.

[Kaliber in reply to Still_in_shock]

Prolly depends upon where you are … never been mentioned to me, but my circumstances are probably WAY off the curve. I’m nearly 6 years past when they wanted me to enter inpatient hospice. Thanks for the update.

❤️❤️❤️

[Still_in_shock in reply to Kaliber]

Congrats!!

The reasoning is that if you still have a prostate, it's a PSA "generator", so 2.0 is the yardstick. If no prostate is present, only PCa cells generate PSA, so 0.2 is the high limit.

Another reason ultra sensitive numbers as low as the OP's move around, is that other cells in the body produce very minor amounts of PSA, thus is disregarded. Explained to me by my Kaiser oncologist. Thus not allowing Us PSA tests.

[Kaliber in reply to Still_in_shock]

Makes sense to me. I’ve met a number of other brothers waiting in the clinics and infusion rooms. All that I have met also get the .1 test as well. I’d expect, hope even , that if the micro numbers were important, that that oncologist would order that type of test. Kaiser can be weird at times tho. Lol. I’ve had 5-6 oncologist there and they have been unique individuals for sure. My pallitive care doctor / team has been real nice to me and takes up a lot of the slack from a busy oncologist.

❤️❤️❤️

[dhccpa in reply to Kaliber]

You are a hardy soul, Sir! And you have maintained your kindness and sense of humor in many posts over the years. Carry on!

[Kaliber in reply to dhccpa]

Thank you very much.

❤️❤️❤️

[God_Loves_Me in reply to Still_in_shock]

Agree It is best advice.

[Simonapo in reply to Kaliber]

Thank you so much, continuing health to you too❤️

[Simonapo in reply to Kaliber]

thank you very much ❤️

[Kaliber in reply to Simonapo]

❤️❤️❤️

[Rocketman1960 in reply to Kaliber]

I'm a Kaiser guy too Kaliber. I agree with everything you wrote. 14 years into the battle and still standing.

[Kaliber in reply to Rocketman1960]

See there ….” Great minds do actually think alike “ , rotflol. 😂😂😂

❤️❤️❤️

[Tall_Allen]

Kishan is the best!

[vintage42]

Like your dad, I had radiation (IMRT) to the prostate in 2021, with recurrence appearing in a Mar 2023 scan and growing further in a Dec 2023 scan. He is the only other person I have heard of to also have radiation failure. Perhaps mine was exacerbated by not starting ADT until Dec 2023.

I am told that since I now have mets to nodes, I cannot have salvage treatment of the radiated prostate, not only because of high risk of collateral damage, but because it would be pointless in view of the mets. So I must rely on the ADT to check the growth of the cancer remaining in the gland. The ADT that I started in Dec 2023 (Orgovyx and Abiraterone) quickly dropped the PSA from 3.78 to 0.03.

[Simonapo in reply to vintage42]

Thank you so much, glad to hear your PSA dropped to 0.03