PSA < 0.1 for five years after RALP then 0.23 at six-years and 0.40 at 6.5 years. PSA has now dropped to 0.30 in mid-March 2025. But, during the six years leading up to the 0.23 value my PSA dropped by at least 25% over a 12-month period on two different occasions.
Oncologist says my PSA ups and downs are unusual and make decisions difficult. He wants me to talk to a local radiologist. The guy has 30+ years practise and is a Harvard Med Radiation fellow and then professor. He is building a proton facility not far from my home and it will be online in late summer 2025.
PSMA/CT Scan early February 2025:
Conspicuous foci of PSMA uptake in the left deep pelvis likely associated with small nodes, suggesting locoregional nodal metastatic disease
No other PSMA avid lesions or nodes to suspect recurrence in the prostatectomy bed or additional metastatic disease.
It will be interesting to see how a highly experienced radiation oncologist interprets my post-RALP PSA history. I am sneaking up on a 78th birthday and am in excellent health and physical condition. My post-RALP tumor genetics by DeCipher showed a very low probability of metastasis which leads me to think I might postpone radiation for a while.
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OldTiredSailor
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It is inconvenient - that is no good reason I know.
As a result of the PSMA/CT-Scan my cardiologist has now introduced a serious comorbidity about which I was quite ignorant - congestive heart failure.
I have been a serious runner and bicyclist my entire life, beginning prior to high school. I have gone to extremes to ensure my cardiovascular health. Due to my exercise levels and very high heart rates I have had a nuclear stress test done every five or so years since I turned 40. I always run the Bruce Protocol off the top of the scale and have had almost no heart issues.
My only cardiac problem is hypertension which is easily controlled with medication.
The PSMA radiologist found "severe plaque calcification" in several major arteries, including coronary. He sent an urgent note to my cardiologist who ordered a Angiogram CT with contrast - the gold standard for diagnosing such problems.
The cardiac radiologist and my cardiologist agree there is an indication of minor blockages but none are sufficient to require treatment or even current monitoring.
BUT - for some reason the cardiologist now says I am suffering from significant "congestive heart failure." I am trying to get more details because ALL my cardiac measures, done by my cardiologist, indicate near perfect results. My ejection fraction is 65% and has been so for 30-years. My PRO BNP value is 35 where 200 is considered concerning. My lipids are all very low and have been for my entire life.
The only measure that I see to be of concern is my aorta is 3.8cm diameter. A value of 4 is the beginning of concern (Gleason 7) and anything over 5 is life threatening. I have four prior measures of the aortic diameter going back 22-years and it has not changed 1 mm.
But - the bottom line for my oligometastatic prostate cancer (my oncologists statement) is that most Congestive Heart Failure sites report only a 50% survival rate at 5-years and 30% at ten years.
Why should I bother with radiotherapy if I have only a 30% chance of surviving long enough the prostate cancer to be symptomatic?
And...the PSMA/CT-Scan radiologist only says: "Conspicuous foci of PSMA uptake in the deep left pelvis likely associated with small nodes, suggesting locoregional nodal metastatic disease"
He also said: "No other PSMA avid lesions or nodes to suspect recurrence in the prostatectomy bed or additional metastatic disease."
The PSA dropped by 25% from early December 2024 to mid-March 2025. At the level of 0.3 the PSMA scan probably did not properly locate the met. So, why start radiation if we don't know the location to irradiate.
I might wait another four-months or until my PSA is above 0.60 where another PSMA scan might identify the source of the rising PSA.
"So, why start radiation if we don't know the location to irradiate." We do know. There is a known "natural history" of prostate cancer progression. Even the best PET scans have lousy sensitivity -- about 40%, which is worse than a coin flip. You have to treat what you can't see, based on the known natural history. Progression occurs whether you see it or not.
There is a new facility in Grand Rapids, Michigan. It is the "World's Most Advanced Theranostics Center". It is worth checking out: bamfhealth.com/ This method attaches just to the cancer cells and kills them... no collateral damage. Medicare approved.
Spent an hour with a very experienced radiologist/oncologist. Harvard and Duke professor with many prestigious publications - 40 years experience.
His Nurse Practitioner spent 30-minutes with getting history and current status. The doctor then spent 45-minutes with me, 25 of which were spent with he and I reviewing my PSMA CT-scan.
His opinion is the scan results are too inconclusive to indicate the need for radiotherapy. My PSA dropped from 0.40 to 0.30 between early December 2024 and mid-March 2025. We spent quite a while looking a scan slices and he said one of the two "possible" PSMA avid lesions was in fact the ureter and it was physiologica PSMA pickup.
The other very small lesion was too indistinct and not "bright enough" to convince him it was a PCa metastasis.
We spent a lot of time reviewing my post surgery PSA results. Given the PSA ups and downs and lack of current PSA growth and his uncertainty about the "possible" lesion - he was comfortable in waiting to specify treatment until the PSA shows a distinct trend.
But - he also said he could do five sessions, (Monday thru Friday), of hypo fractioned photon therapy and certainly kill whatever we could see on the scan.
For now - I will wait until my late July appointment with the oncologist who has been managing my case.
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