PSA rise but no metastasis

[MiRob]

A friend of mine had treatment for oligo metastatic disease and has been placed on ADT treatment for 2 years afterwards before he started a ADT pause. (Supported by his medical team)

He has been off the ADT for a little over a year now and his PSA has steadily increased to around 4,0. (He still has his prostate)

The issue is that no new metastasis shows up on the scans nor do the old bone lesions show any signs of recurring PC. He do not suffer from any of the medical conditions that could cause elevated PSA.

(He also had several PSMA pet scans during the last year all showed no signs of PC activity)

What could be the cause? His medical team have no answers of the cause.

His doctors want to put him back on ADT now but he is in doubt if its an idea to wait for visual signs on scans of recurring PC.

[Tall_Allen]

Just because you can't see it on imaging, doesn't mean there is nothing there.

[MiRob in reply to Tall_Allen]

True TA. But he is in doubt if it’s an idea to wait for visual signs on scans of recurring PC to find out if this/these spots could be treated with radiation therapy before going back on ADT. Your thoughts? Thank you

[Seasid in reply to MiRob]

Just don't wait until you see the cancer. Start ADT.

It is a bad idea to wait for the cancer to show you and spread. How did you come up with this idea? Just curious.

[MiRob in reply to Seasid]

The idea was use the “open window” before being placed on ADT to remove any few PC spots found if possible. (Oligo metastatic belief. And only if max 2-3 spots show up) Some at The Mayo Clinic share the same beliefs.

[Seasid in reply to MiRob]

It is a bad idea. I would rather go back to ADT and maybe later have a new ADT Holliday. Believe me this was discussed here multiple times.

To wait for the cancer to show up on the scans in order to radiate it is a bad idea. You should actually be happy that nothing shows up and go back to ADT and maybe later have a holiday again.

[MiRob in reply to Seasid]

Thank you will tell my friend.

[Tall_Allen in reply to MiRob]

That's why I think Kwon harms patients.

[Bestdays in reply to Tall_Allen]

What is Kwon?

[Murk in reply to Bestdays]

Maybe he was referencing Dr. Kwon and High-intensity focused ultrasound for the treatment of prostate cancer??

[Bestdays in reply to Murk]

Thank you, that makes sense.

[Xavier10 in reply to Murk]

no, he is referring to something else. Kwon likes to use the Choline scan, even today. Not sure why, when there is something a hell of a lot better. But he does wait for scans to pick it up. I think he figures the Choline scan picks things up quicker. But it is also more inaccurate

[Mgtd in reply to MiRob]

Is he being treated at Mayo?

[MiRob in reply to Mgtd]

No he is being treated in Denmark and Finland. But Mayo is considered one of the best places for the treatment of PC.

[Oeje14 in reply to Mgtd]

I want to get the MRI there much more accurate. Looking into it but when I email them they don’t get back to me.

[Tall_Allen in reply to MiRob]

I agree 💯!

[Seasid]

Radiation is also not fun. It is better to avoid it. It has side effects plus something can always go wrong.

[MiRob in reply to Seasid]

True. I myself have had it twice to a PC metastasis in the bladder.

[Seasid in reply to MiRob]

My strategy is to delay radiation therefore I am on ADT. Actually I had prostate radiation but to the radiation most resistant strain survived and now I am Bicalutamide and re-irradiation of the prostate is either not possible or it is very toxic. I am happy as it is now. I definitely don't want to stop Bicalutamide and reradiate my prostate if I can avoid it.

[NanoMRI]

I learned this disease grows at very low PSA values and spreads ahead of PSA and radiological progression. After having had four PSMA PET CT over seven years I wonder if my remaining cancer is PSMA avid; or is it that I do my imaging before 0.1? I rely on several comparative imaging methods and second radiological opinions - no singular imaging method and no singular radiology opinion. Also, I utilize liquid blood biopsy testing for a third leg of investigation.

[Seasid in reply to NanoMRI]

You should get FDG pet scan at some point if you wish to exclude PSMA negative cancer. But that is hopefully not yet your problem.

[Seasid in reply to Seasid]

You may wish to read the following post about scans:

healthunlocked.com/advanced...

I found it useful.

If I wish to see if my cancer is really alive (my PSA is 2.3 on degarelix ADT injections and Bicalutamide.) I should get FDG pet scan.

[MiRob in reply to Seasid]

Thank you for the link 🙏🏻

[NanoMRI in reply to Seasid]

many opinions of course. As I commented I do comparative imaging. To date not FDG for prostate cancer; just did one for my melanoma but it is different. Based on my efforts and consultations I would likely chose Choline over FDG - yes I am aware of what some say. Also in contradiction, I get imaging at very low PSA values because I am not willing to let cancer grow in size (and volume) to where darn near any imaging might work. But then, I walk a different path which to date is serving me very well. All the best to all of us looking for this beast to determine treatment strategy.

[MiRob in reply to Seasid]

You are correct. My friend also had some NAF PET scans along with the PSMA PET scans. Nothing showed up on these either.

[NanoMRI in reply to MiRob]

I find liquid blood biopsy testing - looking for circulating signs - very informative. These can present ahead of PSA and imaging. I've had three to date - first two NED. Third, surprisingly and fortunately, provided a heads-up on very unexpected metastatic melanoma; giving me a true curable opportunity.

[Xavier10]

Could always be the prostate doing something it's supposed to do. I don't have any answers for you. PSA is not the be all and end all of PCa.

[Flapr]

I had laser ablation in 2018 and my PSA started to go up. All the MRI were negative but the PSA pet scan show it. The Biopsy was positive and had SBRT. My PSA for now is low (.58)