Might be on a radiation trial.

[Cramlingtonboy]

I had a non-robotic RP last October (Gleason 8; margins clean but seminal vesicle involvement) and after 3 months my PSA was .22. Nothing was found on a PSMA PET scan and I just started my second Eligard 3-month dose. My PSA is now non-existent which is a good thing. The next step is radiation and I may be able to get on a trial of a new 5-session treatment which uses a stronger and slightly longer duration dosage but they feel will be just as effective and with fewer side-effects than the 17-session pandemic protocol currently used at Sunnybrook. The only fly in the ointment is my hip replacement which they think could cause some reflection issues. They'll let me know which one I'm on after the simulation / tattoo session next week. Either way, I should have the radiation over soon. Apparently prep for the 5-session needs to be more rigorous with enemas before each one so that things are always precisely in place!

[Hidden]

Same case here except GS9. 5 weeks after RALP PSA was 0.02. At 3 months 0.12. After this and for 5 months back to 0.02. Then, 0.03 and currently, one year later, 0.04. Hope that you didn't base all of your subsequent treatments on a single PSA lab at 3 months.

[Cramlingtonboy in reply to Hidden]

Good point; my PSA seems to be holding steady - it was .21 two weeks ago.

[Hidden in reply to Cramlingtonboy]

Yes, but you are on Eligard now, so you don't know where you would had been without it. I have 7 PSA labs within the last year and would have had more if only COVID was not around. Check and double-check everything before the kick-off of your next step.

Rush is not your best advocate.

[Cramlingtonboy in reply to Hidden]

Sorry; I'm befuddled today. It was 0.21, 3 months after the 0.22 initial PSA. THe latest is 0 after 3 months on Eligard.

[Hidden in reply to Cramlingtonboy]

The older rule defining a recurrence foresees three ascending PSA values above 0.2 timely spaced at least one month from each other. Currently, the cutoff point is heading towards 0.1 but the 3 ascending PSA values prerequisite remains as strong as ever, if not stronger.

[Tall_Allen]

I'm sure they also told you that you have to have a full bladder. I know someomeone with a hip replacement who had SBRT - they used a special CT and no MRI for planning to avoid artifacts. Do they intend to treat the entire pelvic LN area?

[Cramlingtonboy in reply to Tall_Allen]

Thanks for the SBRT acronym - I was able to look up the procedure. Yes, they mentioned the full bladder along with a bland diet to avoid gas. Don't know what area exactly they're treating. Since there's no trace of mets, it's probably a wide area around the prostate site.

[Tall_Allen in reply to Cramlingtonboy]

Some call it SABR, but it's the same thing. They recently found that they were not treating wide enough, and there was a survival advantage to salvage radiation of the pelvic lymph nodes even when no cancerous nodes were detected on a bone scan/CT, but you've had a PSMA scan, so it's more of a judgment call. Your persistent PSA, your seminal vesicle involvement, and your lack of positive margins argue for pelvic LN treatment. The potential toxicity of the expanded treatment field is the downside. Here are some relevant articles that might help you make a decision (or may confuse things more!). At any rate, it's worth a discussion with your radiation oncologist.

prostatecancer.news/2017/02...

prostatecancer.news/2018/10...

prostatecancer.news/2017/12...

[Cramlingtonboy in reply to Tall_Allen]

Thanks so much!

[tsim]

Should not be a problem with Stereo beam, make sure you go to a top notch institution.

[Hidden]

Good luck with the Rt. I got the tattoos and a gold markers put in my prostate . I was beyond surgery. The good news is imrt and double adt put me in remission four years now. I hope the same for you . I’m on a trial adt drug. I get thorough testing due to being in the test. Go for it and cure yourself .🌵