New decisions (?) 30 months after RP

[Paulo1968]

Hi everyone,

After RP I can say my PSA has been at 0.03 for 2 years. After this períod PSA showed 0.05 for 3 months, Then 0.06 and now 0.08.

I had a doctor appointment this last Tursday. I mentioned my worries about the increase. His advise is to wait till 3 more months (however he even suggested me doing a following test 6 months later), given following reasons: still low and still zero for him till 0.1; at this level no exams will show anything, my post-op results were good despite the 1mm positive margin which he neglected the importance as it was too small.

Well, if I haven’t followed this group as well as read a lot about the topic, I would be relieved by his words... but I am not.

What is your view?

Thanks in advance, Paulo

[Dionysos]

Boa noite Paulo, the same doctor who told you that the positive margin was of no importance, tells you now that a psa of 0.08 is as good as zero. How can he tell that to you? If it was a stabile value, yes. But not at a steady rise like in your case! Probably caused by remaining and replicating prostate cancer cells. Take the responsibility your self, and search for a doctor who takes you serious.

Best regards, Henk.

[Paulo1968 in reply to Dionysos]

Thanks Dionysius, I looked already for another doctor opinion when the result went up from 0.05 to 0.06. He didn’t say much different ... except that he advised to look for radiotherapy even if no exam would show anything if it would go till 0.1.

Difficult to say. I trusted my doctor, I was to pushy even but he argued back always

I will have a couple of weeks of inner thoughts.

Appreciate your view and answer and I will keep this forum posted about my next steps.

[Tall_Allen]

A major clinical trial called RADICALS-RT showed that waiting for 3 consecutive PSA rises or 0.1 is as good as immediate salvage radiation. With your high risk disease (GS 8), I think it's important not to wait too long. Other advantages of not waiting include that you will not need hormone therapy with it and they can just irradiate the prostate bed. Salvage radiation comes with increased risk of incontinence and ED, so it is not a decision to take lightly. Because of the pandemic, some top radiation oncologists are recommending hypofractionated salvage RT (20-26 treatments) instead of the usual 40-44 treatments.

[Paulo1968 in reply to Tall_Allen]

Thanks Tall_Allen,

Very often I doubt whether I interpret properly these studies... sorry! According to my situation I still fall in the cases I better wait ... as there is only 1% of better result If I get the prostata bed irradiated just now. Is that so?

Appreciated your comments again please.

[Tall_Allen in reply to Paulo1968]

No. The risk goes up very quickly with increasing PSA: If you wait until PSA reaches 0.2, outcomes are about twice as poor compared to doing it now:

prostatecancer.news/2016/09...

[Paulo1968 in reply to Tall_Allen]

Thanks. Clear then.

[billd9946 in reply to Tall_Allen]

Interesting to know. I finally found a PSMA trial and have been accepted for participation. My scan is next Wednesday and assuming no distant metastases, I’ll begin salvage radiation. I must ask about the hypofractionated.

[Bcgkelly]

Hi Paulo, Sorry to hear your news even if no doubt you expected it. At your point I went to Germany for a PSMA scan to find the cancer and it was in a lymph node outside the prostate bed but then the cancer was in my lymph nodes when I had surgery. Following this I had radiotherapy to the node. If I understand Tall_Allen & as it wasn’t in your lymph nodes radiotherapy, when you reach 0.1, to the prostate bed and the positive margin should do the trick but be aware there will probably be side effects. Side effects may not be as bad I think if you’re in good condition. I mean no bladder or bowel issues at present and reasonable fit. Unfortunately radiotherapy seems to be inevitable for you. Try not to let it get you down too much. You will get through it. My advice is to enjoy the next few months until treatment is needed.

Bill

[Paulo1968]

Thanks Bill, I am not letting me down with this. I sleep still very well :-). I am more the type of person who wants things planned with time with all information there is for the decision.

[calexviana]

Hi Paulo. I hope your doctor is right and theres nothing to worry about. Have you been followed by the urologist/surgeon who performed the RP or by an oncologist? All the best

[Paulo1968 in reply to calexviana]

I have been followed by my urologist. I had a second opinion appointment with an oncologist / urologist specialist and good to another doctor appointment at the end of October.

[cpl901]

hi paulo when did you have RP how was the reeducation after ?