New user! PSA rising after T restoration

[BroncoRick]

Full treatment story in bio but in short, after BRACHY, external bean radiation and 2 years of successful T suppression (PSA=0 for 2 years) now 10 months into T restoration my PSA is above 2.0. I have a PET scan scheduled in two weeks but was disappointed that my BEST CASE is shutting T back off the rest of my life (if scan finds anything elsewhere, if count is low, spot treatments).

Feels like a "cure" for my cancer is no longer an option but rather I can only "manage" it now? Can't I jump to chemo now rather than just T suppression? Most other treatments start AFTER T suppression begins to fail (PSA rising even with T shutoff) and I feel I'm healthier to take chemo now rather than 5 years from now when T suppression begins to fail.

Are there other treatment options other than just waiting for hormone therapy (T suppression) to fail?

[Tall_Allen]

I think you're getting ahead of yourself. A biochemical recurrence is not the same as a clinical recurrence. You have to investigate reasons for the PSA rise. I recommend you get a Posluma PET scan -- there are fewer false positives in and around the prostate caused by urinary excretion of the radioindicator. If negative, keep tracking PSA every 3 months to see if it keeps rising or if it falls (probably then attributable to some prostate inflammation).

[TylexGP]

Hi Bronco,

I agree with TA. Also have you had any genetic testing? Just helps you to see if there are additional treatment options if you do develop a clinical recurrence. We are very similar in DX and treatment. My PSA has come up some currently 0.12

[BroncoRick]

Thx Tall & Tylex, the PET scan is scheduled for Feb 26. Perhaps that why the doc is waiting to shutoff T until after scan result. I did have genetic testing 3 years ago when first diagnosed. Only big takeaway is they were looking for one marker (BCNA?) linked to prostate cancer and I did NOT have that one marker.

[j-o-h-n]

Greetings BroncoRick.... Would you please be kind enough and tell us the name of your ONCO and your location and the name of your treatment center? All info is voluntary but it helps you and helps us too. Thank you and keep posting!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[BroncoRick in reply to j-o-h-n]

Hey John, I'm new to the forum and aren't comfortable sharing names yet. I will share I'm using an HMO so the ONCO name is probably irrelevant as in the HMO they tend to run the same playbook. I did get a 2nd opinion at a dedicated cancer center in Denver on the initial treatment plan and are debating whether to take the new treatment plan elsewhere for review but first step is to wait for the PET scan results.

[j-o-h-n]

Thank you for your reply.....and we understand when to be shy. Just keep posting cause you've come to the right place for information and comradery. Regards from all of us.

p.s. Getting second (or more) opinions is always a plus.

Good Luck, Good Health and Good Humor.

j-o-h-n

[BroncoRick]

UPDATE: My PET PSMA scan found cancel in some lymph nodes. Doc calls them small, the two largest are 4 & 6mm under the collarbone and along the spine. Going back on ADT ASAP (Lupron & Aberiterone) but nothing else yet. Will watch PSA which he said should drop pretty quickly (within first month?).

[Don_1213 in reply to BroncoRick]

I wonder why he didn't consider radiating the lymph nodes. If those are the only spots that recurrence is happening wacking them with some photons or protons might be a useful thing to do... the ones near your spine probably would make protons a really good idea.. (vs photons.)

Just to be clear - your sequence of events was - radiation (beam and brachy) followed by ADT for 2 years (0.0 PSA - actually not uncommon when on ADT after radiation), then when finished with the ADT you moved immediately to TRT?

The typical scenario for TRT for a PCa radiation treated patient is a longer period of very low PSA numbers before starting the TRT and after coming off the ADT. In my case it was over 3 years of 0.23 and below after completing ADT before my oncologist felt comfortable in allowing TRT.

My experience with T levels were mine initially started to recover naturally after completing 18 months of ADT. My T got up in the low 300's (OK for an old guy), I felt better and sometimes even horny - then it just went away. T just disappeared - down to around 100, and I got sore, fatter, grouchy and no libido at all. We started TRT about 3 months ago and so far - OK. My T is up around 500 or so, my PSA did rise a bit, but still below the levels it was at when I had naturally recovered T floating around. It's being closely monitored. The goal is to keep me at a normal level for an old guy, and keep an eye out for any serious rise in PSA.

Is the doc you're talking to a radiation oncologist? If not you might want to talk to one about the possibility of zapping the buggers in your lymph nodes and back..

Good luck, and let us know how you make out.

[BroncoRick in reply to Don_1213]

Yes, the sequence is right but they didn't do a literal "TRT" other than stopping ADT. My T was funny too ramping up naturally 6 months to about 200 then when checked 3 months later, dropped a little below 200. He wouldn't zap the 2 lymph node as he said there were "several others" that were two small to zap. if there WERE only 1-2, they said they would but not leaving the other ones. I have time to still get them zapped.