I know things have changed, just curious

[fourputt]

12 years ago when I was diagnosed my biopsy came back at 4+4 =8. I was 62 yrs old at the time. I subsequently had surgery and they found the cancer was contained and I was downgraded to 4+3 = 7. I then went six years until I needed SRT, and have now gone 6 more years and my PSA is easing upwards again. Out of curiosity, with all the new scans, biopsies and such available, how would my case have been handled differently today ? IMO I've been blessed and no matter what answers I receive I am grateful for where I am and the treatments I've gotten .

[MSTI]

Maybe short time ADT before salvage RT ?TA we are awaiting for your opinion🥸

[Wharfster]

Hi fourputt - your feedback has given me some hope.

I’m not a doctor but your diagnosis and treatment sounds similar to mine.

I’ve been told that after the RRP there is a chance the cancer will return at some stage.

Then probably radiation and then whatever the experts recommend.

I’m their hands!

PS - your golfing ability sounds very similar to mine as well!

[WisdomSeeking]

These days there would be also PSMA PET scan additionaly to the biopsy. If the PSMA PET would be clear then, I think, for GS 4+4 preferably RT + ADT.

[BubbaC in reply to WisdomSeeking]

Hey WS- Interesting because I've asked for a Pet Scan and was turned down, which is inexplicable when I'm coming up to almost 3 years on ADT. I'm seeing the doc in a few weeks and will push again.

[WisdomSeeking in reply to BubbaC]

Your doctor may be right. 2 months ago you've written that your PSA is negligible.

[BubbaC in reply to WisdomSeeking]

Yep I did but the purpose of the ADT was to do just that; make it undectable. My concern is that because of the severity of my cancer, it's likely to return or have been missed. My understanding is that the PET scan is so effective, it will spot any leakage cancer cells that can be dealt with immediately. If there is no evidence of spread I can stop the ADT, which after all this time is a bit wearing. I can keep going with the ADT, but I'd like to return to my former life with minimal worries.

I appreciate hearing back from you!

[WisdomSeeking in reply to BubbaC]

You are right that ADT may affect detection sensitivity of PSMA PET scan.

PSMA PET scan is not a miracle. It shows only tumors larger than 5 mm. See: healthunlocked.com/advanced...

I don't know what PSA you need to have in order to be eligible for PSMA PET after EBRT.

With prostate surgery it's simple: once you have PSA over 0.2 it is qualified as biochemical recurrence and you may go on PSMA PET scan. With radiation it's different because you still have the prostate.

[BubbaC in reply to WisdomSeeking]

Thanks again for sharing your perspective! First, I'm glad I didn't go for the surgery, I have a friend who went that route and he's still dealing with issues three years later.

Regarding the PetScan, I understand there are always limitations, but after 30 months of ADT it would be nice to see if I need to keep going. As it stands the PSA tests will be after the fact if there is a reoccurrence. Seems backwards to me.

Regardless, I guess I'll find out in the next few weeks where this is going.

Appreciate your thoughts!

[WisdomSeeking in reply to BubbaC]

As per NCCN guidelines a recurrence after RT is when PSA increases by 2 above PSA nadir (lowest point) with or without ADT:

"RTOG-ASTRO Phoenix Consensus: 1) PSA increase by 2 ng/mL or more above the nadir PSA is the standard definition for PSA recurrence after EBRT with or without hormone therapy; and 2) A recurrence evaluation should be considered when PSA has been confirmed to be increasing after radiation even if the increase above nadir is not yet 2 ng/mL, especially in candidates for secondary local therapy who are young and healthy. Retaining a strict version of the ASTRO definition allows comparison with a large existing body of literature. Rapid increase of PSA may warrant evaluation (prostate biopsy) prior to meeting the Phoenix definition, especially in patients who are younger or healthier."

Source (accessible after creating a free account): nccn.org/professionals/phys...

[BubbaC in reply to WisdomSeeking]

Got it! Just saying the process seems a bit backwards. Why not get ahead of any future issues?

[Laguy01]

seems to me they are going radiation route more. I am scheduled for proton radiation soon, starting shots and pills for hormones therapy. Have an appointment today to consult another doctor. I expect to be put on chemo also. . My cancer has gotten into my lymph node and was told Stage 4A.

[tarhoosier]

I will assume you mean how would it have been different at time of diagnosis and treatment.

Today you would be diagnosed as a Grade Group 4. Pathology terms and divisions have changed since your diagnosis. Gleason Grade is the same and the combination of primary and secondary still apply but the Group numbers reduce the potential range at diagnosis.

Something that is more common now than in 2012 is combination radiation treatment. Brachytherapy combined with beam radiation to sterilize the gland and also the tissue just outside the prostate and also the pelvic nodes. This is a modality offered to 4+4 men now which was much less common at the time of your diagnosis. Androgen deprivation as a part of the RT protocol.

I hope it is more common now for patients to seek and be offered consultations with radiation oncologists and medical oncologists prior to primary treatment.

Several new drugs are available now compared to 2012 for recurrent and advanced PCa so your treatment NOW will be different to those men who are where you are today, but in 2012. This part of the thought exercise is too complex and without real meaning to you.