High PSA upon diagnosis, treatment , and outcome

[Yokohama2023]

Hello,

Diagnosed 9 months ago with Gleason 7 unfavorable… 2 4+3 ,2 3+4, and 1 3+3 ..on one side only ..I guess my high PSA score made it unfavorable , PSA 18. As a result had aggressive tri modality treatment .. brachytherapy seeds, 15 linac radiation sessions, and 9 months o ADT ..just stopped .. The thing is I’m in Japan and didn’t have access to a PSMA pet scan.. plan to get one down the road now…Anyone else in the same boat? Is it possible to have such a high PSA score and not have metastasis? I had the CT scan , bone scan , and it was clear but not as sensitive..my obvious targeted mass was near the edge not huge .. and the technician didn’t think it broke the capsule. but wondering if anyone had positive outcomes with aggressive treatment and a high PSA score. Take care.

[pd63]

4+3 is UIR pc

[Tall_Allen]

That PSA is not that high. Entirely possible that it is still localized.

[jazzy53]

Hang in there. My PSA was the same as yours but my Gleason score, (9) was higher. After 40 session of radiation and two years of ADT, my PSA is way down (under 1.0) and a PET scan showed no metastasis. Of course, there's no guarantee that things will remain stable and, frankly, I suspect they won't over the long haul because of the aggressive GL 9. But my point is that, based on your numbers, there's an excellent chance the cancer hasn't spread. It's hard, but try not to stress over what might be.

[Yokohama2023 in reply to jazzy53]

Thanks good luck to you. I had a quick strong psa drop to .01 but generally see a lot of people in here with lower PSA scores and in the absence of a PSMA pet scan was concerned about the high score. I do know that that the psa number rose 50% year over year. Long story. Wish you the best.

[CrackerOcala]

Can you be so frank as to acknowledge the degree of impact that you believe both treatments have had on erectile function and urinary function and rectal as well? Thank you.

[Yokohama2023 in reply to CrackerOcala]

Sure, finished brachytherapy beginning of Nov , Linac beginning of Jan .. last hormone shot a month ago.. can get an erection but don’t seem interested to do so. Had an orgasm which was intense and a bit painful (a little came out later pretty dry) . Assume that will change in a few months or so. Urinary function has been fine but periodically have the sudden urgency to pee… have to hold it and get to the bathroom ..though if I hold it the session soon goes away.. was happening more frequently seems to be getting better. Initially having to go 3 times at night but now usually only once. Flow seems similar. I don’t seem to have any bowel issues .. all normal… had SpaceOar.

[cancerfox in reply to Yokohama2023]

I wouldn't assume that some of those functions will necessarily change in a few months or so. I had a similar treatment regimen in 2021 and still am currently experiencing similar side effects. Like London441 says below, "The treatments do have their consequences." Unfortunately. 🦊

[Yokohama2023 in reply to cancerfox]

Yes I heard some worsen a few years out .. I’ve noticed some improvement and will hope for the best. Good luck to you!

[London441]

Your PSA wasn’t all that high and your treatment not all that aggressive. I had a 16 PSA at diagnosis with a lot of 4+3 and several adverse features-tertiary 5, SVI, a positive node.

I am undetectable nearly 5 years later. I did have more ‘aggressive’ treatment than you describe though, so there’s that. Your chances for a favorable outcome are good, depending on one’s definition. Mine is not having (to date) any recurrence. The treatments do have their consequences.

[Yokohama2023 in reply to London441]

I read your bio and you went through alot. Your testosterone recovery was strong and the shortened ADT duration was helpful to me to read. Good luck and stay strong !

[cpl901]

In my case the biopsy showed one G7 leasion on the left side and a small G6 on the right side. I choose surgery, and the path report showed more leasions than the biopsy, but i did the petscan before surgery to be sure that nothing was outside. On the left side the leasion was bugling on the innerside of the capsule but didnt go out. Now 6 month after i recovered incontinence and i m still training recovering ED. (Age 58)

Try to get a psma petscan to be sure nothing is outside.

[Yokohama2023 in reply to cpl901]

Hello thanks, I do plan to once I establish a nadir, regain testosterone and get to a psa level where the scan would detect anything. Good luck to you and your healing.