Prostate Cancer PSA is detectible again

[DLetterman]

I am a 57-year-old male. My prostate cancer was diagnosed in 2019, and I had a radical prostatectomy at Vanderbilt. In early 2023, my PSA went up to 0.12. I underwent a PET scan, which returned negative. However, an MRI revealed a small area at the prostatectomy suture site. On October 27, 2023, I completed 40 treatments of savage radiation. On February 7, 2024, my PSA was 0.014. However, my PSA increased to .130 on July 2, 2024. What questions do I need to ask my urologist? Which doctors do I need to see?

[LowT]

Glad you got the MRI. What is the size of the lesion? Is it in the prostate bed? Don’t understand what prostate suture site means.

How close to the rectum.

Was your GS 3+4 or 4+3?

How high was your PSA prior to surgery?

[LowT in reply to LowT]

If you post in advanced prostate cancer forum you may get additional information.

[DLetterman in reply to LowT]

The grade was Gleason 3+4 or grade group 2.

[DLetterman in reply to DLetterman]

Also, I updated my profile. What additional information would be helpful, so that I receive the best guidance?

[Still_in_shock in reply to LowT]

Prostate suture=anastomosis of the urethra to the bladder neck.

[Tall_Allen]

Was the salvage radiation only in the prostate bed or did it include the pelvic lymph nodes too?

[DLetterman in reply to Tall_Allen]

The salvage radiation only targeted the prostate bed.

[Tall_Allen in reply to DLetterman]

Then you still have a chance to get it if you target the pelvic lymph node area. Talk to a radiation oncologist. If you can, find an RO that uses a Viewray MRIdian or Elekta Unity linac for precise non-overlapping with your previous radiation and avoidance of bowel radiation.

[DLetterman in reply to Tall_Allen]

What are your thoughts on a Decipher Test on my surgical prostate specimen?

[Tall_Allen in reply to DLetterman]

For what purpose?

[DLetterman in reply to Tall_Allen]

Would it be of any help in determining future treatments?

[Tall_Allen in reply to DLetterman]

After second salvage radiation? How?

[Justfor_]

Salvage RT is grossly overrated. My personal assesment is, that at best, it can control PSA for 5 years on a 50-50% succes rate. This was the reason for, in my personal case, I elected to rate it as a measure of last resort. I followed another self inspired route that seems to be working 2.5+ years now. Monthly updated documentation can be found on my thread entitled: " An engineer's Bicalutamide maneuvers".

[lhall2]

I also had a radical prostatectomy at Vanderbilt (Dr Smith 2020). Year later 40 rounds of whole pelvic radiation. Then abiraterone and predistone for 2 years & lupron the whole time. PSA holding at 0.014 but since stopping all treatment May 2024, will test in November for effectiveness. Do you have a medical oncologist? My is Dr Goodman.

[DLetterman in reply to lhall2]

Dr. Barocas is my urologist at Vanderbilt. I’m unclear if he is considered a medical oncologist. If he is not, then I do not have a medical oncologist.

[lhall2 in reply to DLetterman]

If your prostate cancer escaped the capsule, then I would ask for a medical oncologist opinion

[Boacan]

I am on a similar path following RALP in January 2000. PSA remained undetectable until April 2024 when PSA came back at 0.03 - Follow up test on July 12 was 0.02. Oncologist is recommending that we continue monitoring until PSA reaches 0.20 at which time a PSMA scan will be ordered to try and locate the cancer. Oncologist feels it involves the prostate bed and/or pelvic nodes but pathology following RALP was clear margins and nodes. There are many here that can provide recommendations to help you decide the best path to take moving forward. I especially appreciate the advice and recommendations of Tall_Allen as I’ve found his advice mirrors the recommendation of my oncology specialist.

[Mgtd in reply to Boacan]

That was a really long run of 24 years.

I am in a similar boat except I had radiation to prostate and pelvic area 15 months ago. Been off Lupron 10 months. PSA just started rose to .04. Last two tests are the same at value at .05.

I guess we are in the “waiting game” now. Not much you can do at this point.

[Boacan in reply to Mgtd]

My mistake as I actually had RALP in January of 2020. Still it was a good run of 4 years and I have a good team of doctors to work with. My oncologist did say he’s had several men that have gone over 10 years undectable and then had the beast return. Not at all common but it happens. Best regards!

[brilliant17 in reply to Mgtd]

I’m curious being that I just completed my radiation treatments (34) and I will still be on Lupron (6-month) for at least another four months. What was your PSA before starting radiation treatments?

My biochemical recurrence after prostatectomy reached 0.3 before I started radiation treatments. They also slightly moved me up from Gleason 7 (4+3) to a more advanced case based on one post-RP tumor that they found which was a higher grade (4+5) but that isolated discovery did not alter the treatment plan.

Thanks in advance.

[Mgtd in reply to brilliant17]

My PSA was 4.8 prior to radiation. There maybe some confusion. I only had radiation. No surgery. So we do not have the same starting point.

[j-o-h-n]

It would be helpful if you respond to our/your member's questions regarding your questions (What questions do I need to ask my urologist? Which doctors do I need to see?). Communication is a great asset here in H.U. Thank you and keep posting.

Good Luck, Good Health and Good Humor.

j-o-h-n

[DLetterman in reply to j-o-h-n]

Thank you, John. I have answered all the questions that I currently have the answers. I will continue to review my records to answer any remaining questions. All help is greatly appreciated!

[j-o-h-n in reply to DLetterman]

DLetterman <--- added to the good guy list on Monday, 07/15/2024...@ 1:17 PM DST

Good Luck, Good Health and Good Humor.

j-o-h-n

[NanoMRI]

Questions to ask? Based on my experiences and lessons I would be asking my urologist about: 1) comparative imaging with a different contrast agent. 2) if not done, about Decipher testing from my RP pathology. 3) as alternative to pelvic radiation I would ask about salvage extended pelvic lymph node surgery using the frozen section pathology method (not common in US - I went to Europe for my comparative imaging and ePLND). 4) if not done already, about penile rehab (probably late but I would still do it).

I would be seeing an MO also certified in Hematology and asking about 1) blood biopsy testing. 2) additional genetic testing 3) begin exploring various ADT and other drug treatment options.

Hope this helps. All the best!

[LowT]

I just came across your postings again. Must have missed prior post.

Was a Decipher done on your surgical specimen?

How large was your prostate gland and where in the gland was was the cancer located?

Had it escaped the prostate capsule?

What was percent pattern 4 on the path report.

[DLetterman in reply to LowT]

Thank you for reviewing my post.

A Decipher was not done on the surgical specimen.

Had it escaped the prostate capsule? Luckily no.

The grade was Gleason 3+4 or grade group 2.

All guidance is greatly appreciated!

[mac-12]

How many cores tested positive and what gleason on positive cores., percentage of core samples, and size of lesion

Was it both sides of prostate, and positive locations

Each core is 1/3000th of the prostate, AS is an option for some. Maybe advances in immunotherapy finds a solution in near future as advances are being made, even from 5yrs ago.