Post -OP PSA is 5.01. What Questions do we need to ask when we meet with the Doctor?

[Pop_Meme]

Husband's RP was 1/7/22. Pathology report said margins were not clear, tumor had broke outside the prostate gland; and tumor was upgraded from GL 7 to GL 9. We were not surprised that PSA wasn't at zero, but didn't expect it to still be so high. We meet with surgeon for follow up on March 3rd..... and he has already stated we should meet with radiation oncologist, but what other questions should we ask or test/scans should we request considering the PSA is still high?

[Tall_Allen]

Has he had a bone scan/CT? A PSMA PET/CT? He should have both. If the cancer has spread outside the pelvic region he should get started on systemic therapies. If not, salvage radiation should begin 2 months after he starts getting Lupron.

Here are some questions to ask:

prostatecancer.news/2017/12...

You should also be aware of the following clinical trial:

clinicaltrials.gov/ct2/show...

[Pop_Meme in reply to Tall_Allen]

He had clear CT/Bone Scan before surgery but like I said, tumor was upgraded after surgery and tumor had broke outside of gland. We had planned to discuss PSMA scan.

[Tall_Allen in reply to Pop_Meme]

I hope you will consider that clinical trial, it seems perfect for him.

[maley2711 in reply to Pop_Meme]

Did he have prostate MRI before the RP? If so, the results?

[Pop_Meme in reply to maley2711]

No, the only pre-op scans were a CT and a Bone Scan. His biopsy showed only 3 positive cores out of 12, with one being a 4+3, and the others 3+4.... however, upgraded to GL 9, 4+5 after surgery.

[Justfor_]

Non negotiable PSMA PET/CT. If surgeon objects, fire him/her on the spot.

[cpcohen]

>>>. . . We meet with surgeon for follow up on March 3rd..... and he has already stated we should meet with radiation oncologist, but what other questions should we ask or test/scans should we request considering the PSA is still high?

>>>

The surgeon is now out of the picture. He ((presumably) did his best, but that PSA, this long after surgery, and the positive margins, show that there's still cancer -- maybe near the prostate, maybe distant.

I think your questions should be directed to the radiation oncologist. _He_ should be in charge of diagnosis and treatment, from now on. (It's possible that radiation won't be a part of ongoing treatment. In that case, you'll need an oncologist, not a radiation oncologist.)

As others have said, the job now is to find out where the tumor(s) is/are, and figure out what's most likely to kill them, without killing your husband first. Neither of those is a surgical problem.

. Charles

PS -- Tall_Allen gives good advice, and knows far more than I do.

[Pop_Meme in reply to cpcohen]

Yes, I understand that treatment now moves to an Oncologist but our next appointment to discuss the PSA is the post-op followup with the surgeon. He had already mentioned to us after we got the pathology report that we need to meet with a radiation oncologist regardless of what the PSA is..... so we know we will be doing that and probably will meet with a medical oncologist as well. We are at a large university hospital/cancer center.

[Murk]

A couple of simple maybe redundant additional thoughts.

1) Dear Doc, what are your perceived next three going forward steps. This helps in the visualization of a going forward plan .

2) I always believe in 2nd opinions - you mention you are working with a large hospital. For a broken leg most places do, but for this you need to find a great place with proven experienced medical experts help in this specific discipline.

3) Work in parallel, start appointment setting now with Oncologist, 2nd opinions, knowing the next three steps helps with this thinking. I was pissed that when I went through this it was always a singular path with lots of wait on schedules. Some personal comfort will come to you from driving this forward...

[Pop_Meme in reply to Murk]

We started out with a different medical team at another medical facility. We then got a 2nd opinion at UAB in Birmingham AL via the O'Neil Cancer Center, which is where we ended up and where my husband had surgery. UAB has the best to offer in Alabama and many from other areas travel to UAB for treatment. So far we have been very happy with the medical team. Appointments have happened quickly and communication is easy. We fully expect to set up appointments with Oncologist tomorrow during our visit.

[Pop_Meme]

We had the final visit with the surgeon and then met with Radiation Oncologist. Next step is PSMA Pet Scan then we will meet with RT Oncologist and possibly Medical Oncologist to discuss treatment plan based on results of PSMA.