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[Dr_Abby_Normal]

RP @ age 54, G9, 5/54 Lymph Nodes positive. PSA less than 0.01 for 7 months. PSA 0.04 at 11 months. Became a vegan upon biopsy results Nov 2016. Uncertain of the best course of action/treatment next to improve overall quality of life as well as life expectancy.

[YostConner]

Your PSA is still extremely low. Has your doctor suggested a course of action? Most people in this condition would be having PSA testing quarterly and not doing anything else unless there is a clear trend.

[Dr_Abby_Normal in reply to YostConner]

I'm currently being monitored every (2) months by means of an "Ultra-Sensative" PSA Screen. I'm coming up on one year since my own RP this January 18th. My doctor has not suggested any further treatment but wanted to keep me in check closely since my pathology post surgery was upgraded to a Gleason score of 9 and 5/55 lymph nodes came back positive. I don't know what's around the corner for me so I'm just trying to stay abreast of the latest treatments to ensure my oncologist has my best interest in mind and not his etc. I have also had at my request a bone scan as well as a PET scan just prior to surgery - negative. It's crazy how some of these aggressive forms of prostate cancer produce very little amounts of PSA.

[Hidden in reply to Dr_Abby_Normal]

As far as I know, the amount of PSA produced has more to do with the type of prostate cells rather than how aggressive they are. I agree with Yost's post above. I would say you need to monitor PSA and do other blood labs. You're unlikely to see anything with scans with that low of a PSA. I would be paying attention to the PSA and its doubling time. If the cancer is confined to the area around the prostate (local recurrence) then people often get radiation to that area. Otherwise, they generally go on ADT. Of course each person is an individual and you find the best treatment for your situation. Talk to your doctor about it, let us know what he/she says. I wish the best for you.

[Dr_Abby_Normal in reply to Hidden]

The grade or aggressiveness was determined by the dissection and analysis of the respective tumor within the lab after its removal (post RP).The amount of PSA that is typically released by a cancerous growth is often less in the more aggressive forms of cancerous tumors than in the least aggressive. Consequently, the relative PSA value in an otherwise healthy male is not always the best way to detect the presence of cancer. ADT does sound promising. Perhaps a combination of treatments may be even more beneficial. Thank you and happy holidays.

[Hidden in reply to Dr_Abby_Normal]

I think if you are looking at someone who has stage 4 prostate cancer wth a low PSA, then I would agree that there is a high likelyhood that it will be more aggressive. You can't make that assumption from someone who has low PSA after RP which is common.

Check out this study for more details:

ncbi.nlm.nih.gov/pubmed/265...

Here's a quote: ...among patients treated with prostatectomy, lower PSA levels were not associated with increased likelihood of pathologic T3-4 disease or nodal metastasis.

[Dr_Abby_Normal in reply to Hidden]

Strictly speaking of the grade of cancer I’m dealing with based upon my pathology report. There’s more information out there if you’re interested: healio.com/hematology-oncol...

[Hidden]

You can also check the NCCN guidelines concerning treatment of biologically recurrent prostate cancer here:

nccn.org/patients/guideline...