Questions regarding the when(s), how and where(s) of SRT as my uPSA levels have started to rise post-op RP after 2 years.

[jronne]

Posted this in the Advanced Protest Cancer group a few weeks ago so I have those helpful responses,

Any advice, opinion or insight would be greatly appreciated

A big issue is finding the right health insurance plan in case I need treatment in the coming year which is the issue for guys under 65 and medicare. This means I need to know a few options going forward and if the health insurance plan covers them. Hoping for no treatment in the coming year.

A friend of mine just got treated at Stanford with ADT then SRT with a post-op RP uPSA level of 0.05 after 4 years. Blind shotgun prostate bed and lymph node radiation since nothing showed on MRI imaging.

Is blind shotgun radiation preferred over waiting for higher PSA levels, positive imaging locations and targeted radiation?

I am 60 years old

My uPSA was first detectable at 17 months (with b7 vitamin supplements being used)

These b7 vitamin supplements were subsequently eliminated with uPSA being detected again at 26 months post-op RP

Radical Prostatectomy 11/19/2015 with Gleason 3+4 at age 56

uPSA test result history

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19

0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18

0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17

<0.006 0.008 <0.006 <0.006 0.009 0.010

6/5/17 3/3/17 12/1/16 8/29/16 5/4/16 1/14/15

<0.006 <0.015 <0.015 <0.015 <0.015 <0.02

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19

0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18

0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17

<0.006 0.008 <0.006 <0.006 0.009 0.010

6/5/17 3/3/17 12/1/16 8/29/16 5/4/16 1/14/16

<0.006 <0.015 <0.015 <0.015 <0.015 <0.02

my medical history is as follows

Genomic Health Decipher test score 0.22 below-average risk, 0 to 1 scale

Genomic Health Decipher test predicts metastasis risk and longevity for 5, 7 and 10 years out.

11/19/2015 Radical Prostatectomy UCSF Dr Peter Carroll da Vinci robotic surgery

Synoptic Comment for Prostate Tumors

- Type of tumor: Small acinar adenocarcinoma.

- Location of tumor: Single tumor. Left posterolateral midgland and base (1.2 cc; slides B10-12).

- Estimated volume of tumor: 1.2 cc.

- Gleason score: 3+4=7; primary pattern 3, secondary pattern 4.

- Estimated volume > Gleason pattern 3: 10%.

- Involvement of capsule: Tumor invades capsule: left posterior midgland (slides B10, B11).

- Extraprostatic extension: None.

- Margin status for tumor: No tumor at ink, but tumor into capsule is less than 0.1 mm from ink; slide B11.

- Margin status for benign prostate glands: No benign glands present at inked excision margins.

- High-grade prostatic intraepithelial neoplasia (HGPIN): Present, extensive.

- Tumor involvement of seminal vesicle: No tumor.

- Perineural infiltration: Present.

- Lymphovascular invasion: None.

- Lymph node status: Negative; total number of nodes examined: 1.

- AJCC/UICC stage: pT2aN0.

Johns Hopkins (Epstein) pathology 10/13/2015

Gleason Score: 3+4=7

Left Base

2 cores (60% + 20%) (30% Gleason pattern 4)

Kaiser pathology, 9/1/2015

STAGE: T1c

Gleason Score: 3+4=7

NUMBER CORES INVOLVED/TOTAL NUMBER CORES: 2 / 14

TOTAL CARCINOMA LENGTH: 10 mm

PSA 3.2 6/10/2014

PSA 4.8 6/8/2015

PSA 4.4 8/10/2015 (free PSA 7%)

PSA 5.0 9/28/2015 (free PSA 8%)

A) PROSTATE, RIGHT APEX, NEEDLE BIOPSY

-- ATYPICAL SMALL ACINAR PROLIFERATION

-- TOTAL SPECIMEN LENGTH, 44 MM

B) PROSTATE, RIGHT MID, NEEDLE BIOPSY

-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA

-- TOTAL SPECIMEN LENGTH, 30 MM

C) PROSTATE, RIGHT BASE, NEEDLE BIOPSY

-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA

-- TOTAL SPECIMEN LENGTH, 23 MM

D) PROSTATE, LEFT APEX, NEEDLE BIOPSY

-- BENIGN PROSTATIC GLANDS AND STROMA, 43 MM

E) PROSTATE, LEFT MID, NEEDLE BIOPSY

-- BENIGN PROSTATIC GLANDS AND STROMA, 22 MM

F) PROSTATE, LEFT BASE

ADENOCARCINOMA, GLEASON GRADE 3+4 = 7

ADENOCARCINOMA INVOLVES 2 OF 2 CORES AND 10 MM OF 30 MM

The first involved core from the left base contains 3 mm of Gleason grade 3+3=6 adenocarcinoma and the adenocarcinoma is located 6 mm from the presumed peripheral edge (see note).

The total core length is 17 mm.

The second involved core from the left base contains 7 mm of adenocarcinoma. Greater than 6 mm of the adenocarcinoma is Gleason grade 3 and less than 1 mm is Gleason grade 4. The Gleason grade 4

adenocarcinoma is located approximately 2 mm from the presumed peripheral edge (see note).

The total core length is 13 mm.

NO PERINEURAL INVASION IDENTIFIED

[Tall_Allen]

Don't wait for imaging to detect metastases - that is a self-fulfilling prophesy. The latest evidence shows that a PSA of 0.1 or 3 consecutive rises has equal results to earlier SRT:

pcnrv.blogspot.com/2019/09/...

[jronne in reply to Tall_Allen]

my close friend was below 0.1 but had 3 consecutive rises pulling the SRT trigger at 0.04 at Stanford.

they imaged and found nothing which was more or less expected

the retail cost was 1.5 million last summer for the scan, ADT and 40 SRT sessions

his health insurance covered it

my concern is that if I need SRT in the next year or years how do I find a health insurance plan that will cover this as opposed to waiting until 0.1 if I get the 3 consecutive rises?

[Tall_Allen in reply to jronne]

You can wait for 0.1 or 3 consecutive rises.