My PSA started rising after 6 years of being undetectable. July 2023 , PSA 0.10 and July 2024 PSA 0.70 . I had a PSMA pet scan when my PSA hit 0.30 in November 2023 , scan did not show any cancer.
I have another PSA test scheduled for early October; my doctor wants to wait until my PSA hits 1 before doing another PSMA pet scan.
Any feedback would be appreciated
You asked for "any feedback", so here is mine:
There is 1 in a 1000 chance that you had 3 ultrasensitive PSA readings and all three of them had zero as the least significant fractional digit. Remotely likely. You either have had single decimal place PSA and you "beautify" them by adding trailing zeros, or, you had true uPSA tests upon which you are taking some rounding liberties.
Author's message: Get serious with your numbers. They will provide you with far better advice than the random user of HU.
none of the PSA numbers I have listed are ultra sensitive; we moved from Ultra sensitive once my PSA hit .1 my last reading was .7
To the mathematicians who thought of the idea of zero...
Thanks for nothing.
Good Luck, Good Health and Good Humor.
j-o-h-n
I'll have to remember that. I am deficient in math jokes. 😎
Here's one you can thing about.
"What has 16 balls and sings"
Good Luck, Good Health and Good Humor.
j-o-h-n
My any feedback: I too had RP and am 67. As I share, my third treatment, salvage ePLND, done at 0.11, confirmed six cancerous pelvic lymph nodes. IMO, based on my experiences, obtain second opinions on imaging findings, consider fluciclovine and/or Choline imaging with mpMRI for comparisons, and look into liquid blood biopsy testing. I learned to not give this beast time and obscurity. All the best!
You may want to get a PSA a little sooner (like September) to see if your PSA doubling time is speeding up. If so, you may want to talk to your oncologist about duplicating the protocol of the EMBARK or the PRESTO trials:
prostatecancer.news/2022/09...
prostatecancer.news/2023/05...
Thanks Tall Allen. I will tell my MO to reschedule my PSA for September and ask about the EMBARK & PRESTO studies. Do you think repeating the PSMA Pet Scan now is a good idea instead of waiting for my PSA to reach 1
Those protocols do not require a PSMA PET scan. You might be able to prolong your vacation time by radiation to PSMA-identified metastases. If you want to have a PET scan, you should have it within a month of starting Xtandi.
If I understand you correctly, first start Xtandi then follow with a PET scan within a month? Is it possible to do the PET scan first to identify any metastases, irradiate and then start Xtandi?
Thanks for your help
There is a known benefit to hormone therapy, whereas radiation of metastases is a largely unknown benefit, other than lowering PSA. Xtandi may increase PSMA expression for a month.
ncbi.nlm.nih.gov/pmc/articl...
ncbi.nlm.nih.gov/pmc/articl...
ncbi.nlm.nih.gov/pmc/articl...
I appreciate these articles you provided, I have a background in protein biochemistvery, this all makes sense. interesting that Xtandi increases PSMA expression, therefore a good idea to start on Xtandi then follow with the PET scan.
Thanks
TA, after PSA reached 0.51 with your encouragement I consulted a Radiation Oncologist. The PSMA PET scan showed “hot spots” in 3 pelvic lymph nodes. I underwent 5 radiation sessions. PSA last week dropped to 0.39. I’m meeting with the oncologist in 2 weeks. From your response, it seems the long term benefit of the radiation is unknown, other than dropping my PSA, and immediate hormone therapy should be considered. Am I reading your comment correctly? Thanks.
No, your situation is different. You have to keep monitoring to see if you have been cured.
Thanks.
Tall Allen my PSA has been increasing. .06 12/2023 to 2.12 07/2024. Abi 2 years tried Xtandi 1 year and Ubequa neither lowered my numbers. Next step? Trial near Pittsburgh? I am referred to Dr Roby Thomas for a consult Aug 05, suggestions?
Next step is docetaxel, which you should have had from the start.
Thank you. I "think" at that time I was too weak for chemo
I'm good now
I started ADT Lupron immediately after having my PSmA scan because of observable tumor in my pelvis and my left lung. Latest MRI of pelvis done in June 2024 showed no observable mass in the pelvis. My PSA has also dropped below 2 also June 2024. Continue on Lupron injections. Will be looking at the left lung in November.
So it appears the ADT is working, atleast it is stopping or slowing the growth of Cancer as identified in the PSMA. Finally got my primary care Doctor to adjust my medication to see if I can get some improvement in my depression and anxiety symptoms. Was unsuccessful in getting any help with hot flashes as that medication caused me to have an issue with extreme high blood pressure. Still really hating the way I feel on the ADT.
what were you taking for your hot flashes?
You may want to consider doing estradiol (E2) patches for reducing or eliminating your hot flashes. The standard (low) dose is one large patch per week of strength = 0.1 mg E2/24 hr. Ask your PCP for a prescription. Some manufacturers recommend changing to a new patch after 1/2 week (i.e., using 2 patches per week).
I had a PSMA scan twice in the past 2 years after my PSA hit 0.2 (per Dr. Sartor) each time it showed a tumor on a rib and each time had SBRT, 3 sessions and PSA has fallen back to nearly undetectable.
Ef
I did PSMA Pylaryify (sic) at 0.70 and found 2 lymph nodes affected. One in prostate bed which I elected to have removed and one behind my breastplate which we radiated. First PSA test due Labor Day.
Hello there, I am a 76 year old and had my surgery in 2018 then 6 months later had 8 weeks of IMRT radiation. This was 6 years ago. On April 17 of 2023 my Psa was 0.0915, on April 18 of 2024 my psa was 0.366, which means it quadrupled in one year. My oncologist said my numbers were very low but was concerned at how fast the numbers were multiplying so he ordered a PSMA scan. The scan showed a very small nodule in the rear of the prostate bed, a very difficult spot to get to. He recently put me on the 30 day dose of Lupron Depot which has brought my testosterone down to 14 and my psa down to 0.20, good sign the Lupron is working. So my advice is be very vigilant on how fast your numbers are multiplying. I think the criteria for insurance to cover a psma scan is if the numbers are doubling within six months. I don’t want to to take a chance with the surgery because I am afraid it might make my bowel worse than it already is. I also told my doc I would be glad to participate in any clinical trials or tests of any new treatment to help cure this nasty cancer. Best of luck to you..
You are letting them scare you like they tried to do to me. There are ways to drop that PSA 75% in 30 days without strong ADT. I am a living testament of this.
I've been put on Dutasteride (Avodart). I consider this 'ADT-lite'. It dropped my PSA from 3.2 to 1.6 so a 50% reduction. It prevents the conversion of T to dht but doesn't throttle T like ADT does. My latest T reading was 399. I am 74.
I've never heard of this medication for the treatment of prostate cancer. Was your prostate cancer metastatic?
No signs of it being metastatic. Slowly rising PSA after HIFU surgery almost 8 years ago. Axumin, Pylarify and MRI prostate scans all clear. Something of a mystery as to why PSA has been rising but not registering with scans. The cancer is 'hormone sensitive' since dutasteride does reduce the PSA readings.
Please let us know how you did that w/o ADT?
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