Dear Friends, please see Bio for more info. My dad is experiencing his 2nd BCR. PSA has gone from 0.12 to 0.2 in the past 3 months. As I'm aware, he could get a PET / PSMA scan now, or wait for PSA to get higher then have a scan. Due to his experience in the past, this waiting to 'let it grow and spread' gives him (and me) a lot of anxiety. If a scan gives us nothing, should he start ADT and at what PSA, with what ADT is recommended? His oncologist advises starting ADT as late as possible, but from all the research I have read this isn't always the best course.
Thank you for your invaluable input and advice 🙏
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MsBoBo
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I’ve gotten a PSMA scan twice, both times are when my PSA reached 0.2 and both times it identified a tumor on a different rib. Both times I treated with SBRT and my PSA fell back to nearly undetectable. These were performed around a year or so apart. My oncologist, Dr. Sartor is who recommended a PSMA scan when it hits 0.2. Personally I’ve always taken an aggressive approach to treatment and I don’t want the disease to be able to gain a foothold. This strategy was something that Snuffy Myers would preach back when I was seeing him as my specialist. It’s worked for nearly 11 years now, I’m not changing.
I can really appreciate your approach. It reminds me of the statement, "Fu@k around and find out". It's easy to quote various trials but I believe in patient choice. While trials give some background, none of these trials comes with any guarantee.
My Kaiser Permanente RO was willing to wait but my consult outside of KP was very clear. "It's only been 8 months since RALP, obviously you have cancer that wasn't contained, you're too young, you don't wait"!
I had a scan once. Just to say at the outset, correlation is not causation. Before the scan my PSA had wobbled around 18, that following a TURP and subsequent biopsy with a (4+3 or 4+4 depending on who read it). About a month after the scan my PSA began to rise at around 2 per month. Last read was 81. A bone scan uses 5 millicuries of tecnicium 99 (which is a * ton of exposure) concentrated in the area of the met, producing ionizing radiation - a mutagen. PCa genomes have already become unstable and probably cannot repair radiation damage to their genomes. I am not blaming anyone, I understand what it does to DNA and I did it anyway. But, just to say, the payoff must outweigh the risk. My scan was negative. Oh, and just to say, a PSA is not tha t precise. A rise from 0.12 to 0.2, to me, doesn't mean anything. My PSAs before the scan were at three month intervals and were 18.34, 15.99, 18.20.
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