Ongoing BCR update

[MSTI]

Short story:

Now almost 71 yrs old.

RP August 2015.

Pathology: Gleason 4/3, PT3B N0M0 , SVI, PNI, ECE (intermediate unfavorable).

Post RP PSA 0.06

Adjuvant RT to prostate bed finished January 2016. , PSA 0.03

Late radiation proctitis. Bearable.

BCR PSA values :

01/29/2020 0.20

06/15/2020 0.18

08/07/2020 0.16

10/05/2020 0.18

02/18/2021 0.23

04/13/2021 0.21

05/26/2021 0.19

07/27/2021 0.20

09/14/2021 0.18

09/24/2021 0.20 09.21. diagnosed Ramsey-Hunt syndrome, acyclovir, prednisone

11/29/2021 0.34 after two months out of any supplements

12/28/2021 0.22 after a month on supplements

02/04/2022 0.27

04/12/2022 sars COV19 positive. Nothing serious. A few days of common cold. Supplements stopped.

05/13/2022 0.28

06/20/2022 0.31 after three weeks clear of any supplement

07/14/2022 0.20

08/16/2022 0.22

09/12/2022 0.28

12/09/2022 0.28

03/23/2023 0.34

10/05/2023 0.37

04/24/2024 0.41

11/07/2024 0.41

All values from blood draw are OK. ALP always < than low value.

Explanation for slow doubling time?

I guess that Gleason 3 pattern was all what surgeon left uncut.

Anyway, feeling grateful to whatever it is.

[LowT]

Doubling time of little use for values under 0.5.

What were your surgery specifics and full pathology report?

[LowT in reply to LowT]

Ignore the question. Just read your bio.

[MSTI in reply to LowT]

2020. my MO gave me choice to start with ADT if I am afraid of PSA numbers. His advice was not to start with ADT and I was against too.

Was it right decision? Who knows. But I am very content with five good years+ now, when I am not too old.

Some members are suppressing PSA with mild ADT even when PSA rise is under 0.1 limit.

That kind of intervention may be clever, but under SOC it is hard to establish such procedure.

BCR is rather uncharted territory.

[MateoBeach]

I would not start ADT at this time. I would get a PSMA PET scan now to see where remaining cancer is located. And I would strongly consider whole-pelvic lymph node EBRT up to the aortic bibfrucation. That is the standard now for salvage RT at BCR, not just the prostate bed. I was in the same boat as you on that. Found 2 LNs in pelvis only so had pelvic RT with boost dose to the nodes. ADT as ajuvant to the pelvic SRT needs to be carefully considered as there are harms from it as well as helping the RT work better. I opted for 6 months only adjuvant ADT as it appears fine for low PSAs such as you have. Don't do nothing please! MB

[MSTI in reply to MateoBeach]

Thanks MB. Very usefull informations. Local SOC requests 1.0 for PSMA scan for my current status. Not sure 100% but I guess that PSADT counts too, not PSA alone.I have appointment with MO in two days. Your opinion will be discussed.

[MateoBeach in reply to MSTI]

You need it now to make a medical decision about pelvic RT, by excluding metastasis outside the pelvis.

[tn12 in reply to MateoBeach]

At what PSA value did you your psma scan?

[MSTI in reply to tn12]

We are waiting for 1.0 for PSMA.Last PSA (october) was 0.41, exactly the same as six months ago.

[tn12 in reply to MSTI]

Oh ok, I misunderstood. So you've never had one? My husband was also T3BN0 in 2021. His PSA is now 0.06. I was wondering about PSMA. Thanks all the best to you.

[MSTI in reply to tn12]

Too early for him for PSMA. A lot of posts here about timing. Best wishes to all of us.