Rising PSA following Radiation

[prostate_watcher]

about 9 months ago I completed 25 radiation treatments, four treatments of high dose radiation, and a four month dose of Lupron. Three months later, my first blood test showed a PSA of 0.77. Everything looked good. However, my next blood test three months later was 1.7. Three months after that my PSA measured 2.5. My Urologist and Radiation Oncologist agreed that I should have an Axumin Scan (advanced PET scan). The scan results showed no cancer outside the prostate, but some involvement in the prostate. My Urologist is recommending that we watch it for another year. If the PSA continues upward, he wants me to have a salvage prostatectomy. I’ll meet with my Radiologist next week to hopefully hear about other options.

My question, of course, is about experience others have had with this situation. I’m 71, in good health otherwise, and a prostatectomy seems drastic. Thank you for any information you can share.

[NPfisherman]

Hi PW,

My situation was quite different than yours. In this case, you have several choices which include prostatectomy,, SBRT, HIFU, Cryotherapy, or look at getting the new Aurolase treatment using gold nanoparticles. Here is some info for BCR post RT:

core.ac.uk/download/pdf/423...

and here is some info about Aurolase:

sciencedaily.com/releases/2...

and the clinical trial info for Aurolase:

clinicaltrials.gov/ct2/show...

I would not wait around on treatment. If you do not wish a prostatectomy, then review your options and choose.

I would also discuss whether another course of ADT should be done in combination with your choice. I hope you have chosen a prostate cancer center of excellence for treatment.

Best of luck....

Don Pescado

[prostate_watcher in reply to NPfisherman]

I can't thank you enough for this information Don. The sites you've listed have given me much to consider and do further investigation. The choice I make will be complicated and probably won't have the odds of success I'd prefer. However, you've put me on the right track. Gary

[NPfisherman in reply to prostate_watcher]

Gary,

You are most welcome...

Each person on this journey must choose their own path. The fact that things still seem "localized" may not be the case..Micrometastases will not show up on any of the approved current scans....I advise treatment sooner than later and aggressive treatment early can result in cure... I would look at the success rates post RT recurrence for each of the treatments, and side effects, and talk with an MO as well as an RO. Also, many choose to take out "the mothership" --prostatectomy, but there are side effects with that as well. Get to a Center of Excellence if not at one now. I chose Cleveland Clinic rather than go to my local Urologist, and I am glad I did. . Your Gleason score from biopsy may make this more urgent if you are at higher risk (8-10). Last thought, do not wait a year !!!!....

If you have other questions or concerns, feel free to message me or post on the forum. I guess daylight savings time has left the crew here still sleeping this weekend...LOL...

Stay safe and may you travel well on your journey...

Don

[prostate_watcher in reply to NPfisherman]

Thank you again. I had a Gleason score of 7, intermediate risk. I live in Southern Utah and am reasonably close to the Huntsman Center in Salt Lake City and the Mayo Clinic in Phoenix. I haven't been to either one but I think they're good but perhaps don't qualify as Centers of Excellence.

[NPfisherman in reply to prostate_watcher]

You may wish to start here at the Prostate Cancer Foundation website-look at map and type in zip code:

pcf.org/patient-resources/p...

They have a free prostate cancer patient guide also that is excellent in providing so much information.

pcf.org/guide/prostate-canc...

I would look at locations, the MD patient reviews, and get a second opinion. Bring the various choices that you have and get their input. I show up with a list of questions and make sure I get clear answers. If you choose prostatectomy, I advise getting someone that has done over 700 procedures, and I chose a robotic one. I was a G8 at biopsy.

Good luck....

[cujoe in reply to prostate_watcher]

Gary,

I agree wholeheartedly with NP as to the individual nature of our treatment decisions as well as his advice for prompt action. He has provided links to resources that can help you decide on a prudent path to follow.

Following up at either of the centers you mention would be a good first step in that direction. I might be inclined to go with the one where I can get the earliest appointment and go from there. Also, never fear asking for a second opinion. If I had done so, I might have been able to catch my cancer while it was still organ-confined.

Good luck! Stay Well - cujoe

[prostate_watcher in reply to cujoe]

Good, strong advice. Very much appreciated. Gary

[Raymo69]

Sorry to hear, I’ve had very similar treatment for my G8. One thing you said stood out to me. I also had the Axumin PET scan. If my Dr. is correct, the scan detects prostate cells, not cancer cells per-se. So it is completely normal to have your prostate “light up” & have it not appear anywhere else. In fact, I specifically asked him if he had prostate cancer. He said no. I then asked if he had the same scan, would his prostate show the same? He said yes. So when the cancer cells leave the prostate, they carry some of the prostate cells along with it & that is what the Axumin was designed to pick up. With that said, and as NPFisherman has stated, there is an area above & behind the prostate with many lymph nodes that no scan in the world can detect. My radiologist concentrated on this area (along with the prostate of course) when he was mapping my radiation. I’m curious if your radiologist just missed this area. Here’s a picture of the area my Drs. showed me & explained that they find cancer in cadavers in this area by dissection. One of them colored some of the lymph nodes. They always find cancer here even after all the other scans showed nothing. Inbox me if you’d like to chat further & good luck to you!

[prostate_watcher in reply to Raymo69]

Thanks Raymo69 for the detailed post. I've read that the Axumin scan detects the radio tracers I was injected with. It's an amino acid that is readily absorbed by cancer cells. Those cancer cells light up in the imaging and show where activity may be. Two radiologists have told me that those cancer cells may have been well radiated, unable to multiply, and in the process of dying. They are still producing PSA and will for years. I was told that initial PSA counts following radiation nearly always show elevated numbers and sometimes ( but rarely) even as high as before radiation. So in my case, I have a urologist who's ready to call in the Calvary and two radiologists who advise patience based on years of seeing this exact pattern again and again. Nothing is a sure bet....not the PSA test, not the radiation, not the PET scans. All I can rely on is what is typical and seemingly normal and hope for the best.

[Raymo69 in reply to prostate_watcher]

Here’s a good article on exactly what we’re talking about. sciencedaily.com/releases/2...

[prostate_watcher in reply to Raymo69]

That's a good paper. What I'd like to find is a paper confirming what my radiologists said about dying cancer cells continuing to produce PSA and skewing blood tests. The Radiologist I consulted for a 2nd opinion thought that the Urologist who ordered the Axumin scan jumped the gun by ordering it too early.

[NPfisherman in reply to prostate_watcher]

Here is an interesting article on interpretation of the Axumin scan that you and Raymo69 may want to review. I had an Axumin scan when my PSA shot above 2 post RALP. I had SBRT to one bone met prior to the ORIOLE trial findings and was glad that I did.

dmshealth.com/clinical-impa...

[drfranks61]

The recurrent cancer should be able to be treated with Proton therapy.

[Papillon2]

dxd