I’m turning 75 with Gleason3+4 Stage 2b confirmed after RARP in Sept 2019 with positive surgical margin. It was 3+3 preopt so they did not perform pelvic L/N exploration. SBRT in Sept 2020 because of rising PSA from 0.02 to 0.045, and that was before studies recommended SBRT for rising postopt PSA. However, PSA continued to rise, be it slowly to 0.23 in Aug 2023. PSMA PET was negative in Oct 2023. PSA gradually rose till today(Feb 20) to 0.5. The rise in PSA appears to have been linear, from 0.25(Jan2024) to 0.5(Feb2025) now. Asymptomatic, except for the last 6 months I have developed an idiopathic Piriformis syndrome on the right gluteal area, the side where my PCa was. Not responding to PT. A bit concern whether it could be related to PCa. Never heard of that before. Will seek an orthopod opinion hopefully.
When should I go for another PSMA PET scan? I know it is still too early for ADT. Any other suggestions?
Much appreciate.
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HKKWL
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If I were you, I would do further investigation on the piriformis issue. I see no way that is related to PSA. I have had pain like you in that area. Have you had a steroid shot to the piriformis to confirm that is the issue? My ortho did one and it failed to relieve pain. Tells you pain is caused by something else. After all therapy, etc., it still persisted. A new MRI of spine showed narrowing in two spots. Did an epidural injection to L3-4, which was one of them, and going on 3 months now with 80% relief. My options are shots 2-4 times per year, or visit the spine surgeon for a minimally invasive scraping of the area to make more room for the nerve. My advice to anyone is make sure you only go to the best ortho practice available, which is usually a major medical institution, Here in Chicago area, RUSH Orthopedics is the best, followed closely by Northwestern.
As far as PSA progression, I use BROQ, and other items, so I dont have the issue. Here is a link to the study.
Mark Scholz would say that the odds of a tumor appearing on PSMA scan are roughly equivalent to your PSA level (~50% at PSA 0.50, ~100% at PSA 1.0, etc). I think every 6 months is otherwise a standard for getting PSMA scans with rising PSA.
Did you get an MRI to rule out spinal stenosis on your "Piriformis syndrome "?
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