BCF after 9 years post proton therapy

[hwrjr]

My PSA had been increasing slowly since my nadir of .75 in 2017 reaching 1.19 in 2022. Both RO and Uro weren't terribly concerned. I wanted PSMA after 3rd consecutive increase but both recommended a wait and see approach, especially the RO who seems honor bound to wait for 2.0 over nadir.

I skipped 2023 test and now PSA has jumped to 3.2. Uro was surprised at the magnitude of increase and thinks it may be due to prostatitis which is chronic in my case so he prescribed antibiotic and retest in 30 days. His DRE states: "Rectal exam demonstrates a boggy tender left lobe suspicious for prostatitis. Gland measures about 20 g, benign, absolutely no evidence of induration, nodularity. Margins are smooth". I don't know of anyone who has had a reduction in PSA after antibiotics unless it was bacterial so I think this is just a formality. I wanted PSMA now but both he and the RO recommended waiting for retest. I'm thinking of having another PSA at a different lab in a week or so just to rule out lab error. I will be having the PSMA at Duke so I had the Uro's office schedule it for Feb 29 the day after PSA retest so hopefully no further waiting for the scan.

I know the PSMA is the latest and greatest but there seem to be a number of reports about a growing number of pathologies presenting PSMA uptake on PET reported in the last few years, and a proper interpretation of PSMA PET imaging findings suddenly became challenging and, to some extent, confusing.

My hope is the recurrence it's confined to the prostate and is low grade. I would love to avoid HT and treat the cancer if possible. At any rate I guess I'll know soon enough.

[Tall_Allen]

I agree that antibiotics are a waste of time. Perhaps, if there is prostatitis, it will remit on its own.

Ask for the new Posluma PET scan, which is less apt to give false positives in and around the prostate.

[wilcoxsaw in reply to Tall_Allen]

Are you aware of a testing center locator tool or link that identifies where Posluma is available?

[Tall_Allen in reply to wilcoxsaw]

posluma.com/availability

1-877-473-8638

[dhccpa]

You have no MO as of yet?

[hwrjr in reply to dhccpa]

I haven't needed one. Now that I'm npsa+2.0 I'll have the PSMA and maybe other tests at Duke Cancer Center. My MO there will be Dr Andrew Armstrong.

[Starr15]

“and a proper interpretation of PSMA PET imaging findings suddenly became challenging and, to some extent, confusing.”

All imaging studies can have confusing findings sometimes. However, the nuances of reading a PSMA PET are known to all radiologists experienced at reading the scans. There has been no recent discovery of new problems in the interpretation of these scans.