Rising psa after Eligard and bicalutamide, in 9 months. What treatment now to stop the psa rise?

[edgeh]

Had a prostatectomy in June 2018. Two tumors, Gleeson 3+3, with perineural infiltration. Psa went to 0.22 post op by March 2019, before op was 4.12. Went on Eligard and 50mgs bicalutimada when Psa rose to 1.58 in Sept. 2019. Psa fell to 0.10 in Dec. 2019, but has risen to 0.21, in March 2020, then 0.31 in June 2020. I'm on Eligard still and bicalutamide. No other treatment or Petscan etc is available at this time, l live in Mexico. I have to return to Canada for extra treatment when possible but may have to wait 6mths or more. What other medication would one take with a slow psa rise as described. My testosterone now is 3.58ng/ml. Is Casodex a possibility or wait?

Thanks for the help

[Tall_Allen]

Why haven't you had salvage radiation?

[edgeh in reply to Tall_Allen]

I didn't know about it and urologist never mentioned. All my treatments have been private, the regular health system is very poor in Mexico. In my town, there is no machine for that, people have to fly to Mexico City, and right now, the Centre is not operating. I need an interim treatment/l can buy from a pharmacy or on Amazon to tide me over before returning to Canada.

[Magnus1964]

Radiation would be the way to go. But I understand travel may be difficult. We are talking about your life. You could go on another ADT drug but the radiation could be a chance for long term remission.

[edgeh in reply to Magnus1964]

I imagine some imaging is necessary before radiation, correct? What type of radiation would you recommend and for how long? Thanks for the reply.

[Magnus1964 in reply to edgeh]

That would be best answered by a Radiologist. Plus I don't know what available near you.

[edgeh in reply to Magnus1964]

Thank you. It would be private unless l could return to Canada and time is of the essence. Assuming continued rise of PSA over the next 6 months, during which time I could reinstate myself into the health system, is there still time to halt it with radiation?

[Magnus1964 in reply to edgeh]

Yes, you could go on a different ADT drug in the meantime, Maybe zytiga and prednisone. In six months you would be prepared for EBR.

[edgeh in reply to Magnus1964]

That sounds good. Will check it out. Thanks

[fluffyfur in reply to edgeh]

A PSMA pet scan would be your best bet scan wise, I don't know if those are available in Mexico or a neighboring country like Costa Rica? You really need to get a scan to determine if your cancer has metastasized into a node or bone. There is another scan called the Axumin (generic name: fluciclovine F-18) that you could try, but I dont know if it would show anything at your PSA.

If I were you, I would try and do a video or phone chat with a radiation oncologist in the USA and self pay for it. That way they can advise you of next steps. Many are able to do this now because of the pandemic. You just pay ahead of time and they spend about an hour on the phone with you. They can also advise you about meds, scans, and potentially how much radiation you need.

If you decide to do this you have to fax or email them your biopsy and pathology before the phone call. Good luck.

[edgeh in reply to fluffyfur]

Thank you for the info. Must check out the availability. Covid is proving life is difficult for all.

[fluffyfur in reply to edgeh]

There are a few people in this group from South America. Maybe one of their Radiation Oncologists would do an online/phone consult with you as well. Just throwing out ideas. I dont know if you are a Spanish speaker or English speaker but it's always best to communicate in your native language. The longer you wait the more time you have for your cancer to spread. I don't think its something you need to do today, but with a rising PSA its definitely a concern. You possibly still have a chance at remission if you act more quickly....

As for radiation itself, salvage radiation is generally done to the prostate bed with or without lymph nodes. Most people go over a period of several weeks. My husband is doing 7 weeks of radiation every day. Like you he had a rising PSA after prostatectomy.....

[edgeh in reply to fluffyfur]

Thank you so much for your concern. Hablo espanol but as you say it's always best in your own language. I investigated returning to Canada. A PSMA-CT scan can be done privately in Montreal to discover locations of cancer spread at a cost of around $1000.00 can.

However, even though Covid is low there facilities are temporarily closed, so a long waiting time is probable.

I will return to Canada as soon as l can put my affairs in order in Mexico, selling a house, pets, etc. So l was hoping a temporary fix might be available until my departure, but it doesn't appear so.

Thank you again for the support.

[CalBear74]

Casodex is bicalutamide.

[edgeh in reply to CalBear74]

Yes, the same, I really meant to indicate chemo, docetaxel, as the next step up. However, recent threads on docetaxel appear inconclusive as to positive treatment.

[Hidden]

PSMA as advised. Second best abdominal MRI or better multiparmetric MRI.

[edgeh in reply to Hidden]

Thank you for the reply, much appreciated.

[fluffyfur in reply to edgeh]

Pelvic MRI though. Not abdominal..