Greeting fellow sufferers

[Steffman]

After two and half years post RP my PSA has increased from <0.1to 0.2.

Now been referred to an oncologist (3 week min. wait ahead) to consider doing prostate bed radiotherapy.

Been asking around about going private for a 68 Gallium PSMA PET-CT scan as the Urology dept say its more likely than not to be cells left behind in the prostate bed when the prostate was removed. "Likely" but not 100 percent certain is worrying . If its elsewhere I'd like to know now. Urology say until the PSA gets to 0.4 no scan would be worthwhile as the cells wouldn't be detectable. Is this correct?

Also, I'm reading that post prostate bed radiotherapy the PSA can increase for up to 3 years. If they have got the location of the cancer cells wrong how would i know its not developing elsewhere in the body if the PSA is giving a misleading result?.

Just thought I'd share this information to get a much needed view from those better informed about these matters than I am.

Keep well all.

[Justfor_]

healthunlocked.com/prostate...

[NanoMRI]

Your share reminds me I felt similarly (but a bit differently) nine years ago. My post RP nadir was 0.051 and we accepted cancer remained - especially as RP pathology reflected some compromised findings. I did not buy the IMO guess that the PSA was most likely from cells left behind. I accept it was out, but where?

Then and today RT and ADT remain the most common next steps - especially here in US. I was recommended the Stampede trial protocol but declined. I tracked my uPSA rise with monthly testing and at 0.113 went for salvage RT to prostate bed - no ADT. I took that action shooting blind, because imaging was discouraged. Regarding "I'm reading that post prostate bed radiotherapy the PSA can increase for up to 3 years", four months after my salvage RT to the bed, we tested and the result was 0.075; we immediately know we missed again.

If I had a post RP do-over today with what I have experienced, I would be getting comparative imaging including mpMRI and PSMA PET/another flavor and liquid blood biopsy testing no later than 0.1 (yes, I know).

Regarding "until the PSA gets to 0.4 no scan would be worthwhile as the cells wouldn't be detectable", seven years ago post my salvage RT, at 0.13 (yes 0.13) I had a Ga68 PSMA and Ferrotran nanoparticle MRI (had to travel abroad). Although the PSMA was clear the nanoMRI correctly identified multiple cancerous pelvic lymph nodes. Surgery confirmed six including para-aortic - including common iliac; six cancerous pelvic lymph nodes at 0.13. I hope this helps. All the best!

[Tall_Allen]

"its more likely than not to be cells left behind in the prostate bed when the prostate was removed. "Likely" but not 100 percent certain is worrying . If its elsewhere I'd like to know now. Urology say until the PSA gets to 0.4 no scan would be worthwhile as the cells wouldn't be detectable. Is this correct?"

Unfortunately, you will never have 100% certainty. PSMA PET/CT scans can only detect metastases that are 5 mm or larger, and at a PSA of 0.2, there is only a small chance that your lesions will be big enough to detect anything. If you wait for the PSA to get higher, it is a self-fulfilling prophecy -- the lesions will get larger and spread -- not something you want to happen.

We know that metastases travel first to the prostate bed and then to either the pelvic lymph nodes and/or bones (pelvic bones and spine usually first). At your low PSA, you can probably get away with prostate bed-only salvage radiation. If that doesn't do the trick and it spreads to the pelvic lymph nodes later, you can still get a second salvage radiation treatment of the pelvic lymph node area.

"Also, I'm reading that post prostate bed radiotherapy the PSA can increase for up to 3 years. If they have got the location of the cancer cells wrong how would i know its not developing elsewhere in the body if the PSA is giving a misleading result?."

Please provide a link to what you are reading.