Rising PSA - Radiation Therapy

VegasMike

Hi 54 years old. Had my prostate removed 20 months ago, showing negative margins from all lymph samples. PSA has been slowly rising for the 20 post op months starting at <.1 and now last week with it at .19 My urologist/suregeon has referred me to a radiologist for further treatment. I thought I was in the clear, but now once again, confused and stressed about what the future holds. My urologist tried to encourage me that he fully believed it was treatable, but who knows. Feel like I am back at square one and don't know how to proceed and what questions to ask. Said something about 9 radiation treatments, most likely to the prostate bed.

VascodaGama

Vegas,

These increases of the PSA signifies recurrence. Your doctor is now suggesting salvage radiotherapy (SRT) which is the typical treatment recommended for such cases after surgery. SRT is done traditionally in guessing that the cancer resides in the prostate bed because the case has been erroneously identified initially (20 months ago) as contained. SRT is therefore done blindfolded, following the protocol of the NCCN guidelines. Many guys were lucky and managed complete remission with SRT but many others recurred again. It is important to determine the area for radiation that gives the highest probabilities for success.

From your initial post of January 2020, you said that the biopsy was positive for the cores drawn from the base of the prostate. This gives probabilities for existing metastases in the bladder which analysis are not covered by the pathologist when checking the gland specimen. I think that this time you should start by getting a better image study (MRI or PET) and then consult a radiotherapist taking along copies of of the initial biopsy report and of the pathologist's findings on the gland specimen (post RP), to discuss on the field of radiation.

NCCN guidelines recommend SRT intervention when the PSA reaches 0.40 ng/ml. Yours is now 0.20 so that you have enough time to investigate further before committing. PSMA-PET scan is the best in recurrence cases but this is more reliable (lesser subjected to false negatives) when the PSA is higher above 0.70 ng/ml. In your shoes I would wait allowing the PSA to increase.

Best wishes and luck in this journey.

VGama

Fleet Foot

For what it's worth, I'm 75 and I had my prostate removed about 40 months ago with positive margins. Semi annual PSA blood work have all been "virtually undetectable" or <.01. My urologist/surgeon said he wouldn't even consider me for further treatment until at least two successive PSA readings of .2 or above and even then any radiation treatment would first have to be identified via a PET scan. Luckily prostate cancer is slow growing so there's no rush to treatment. Take your time and Good Luck.

Clevelandguy

Hi,

Good advice from the two survivors above. Sounds like they might have to do some radiation mop up in the future. Like Vasco said you might have to wait some time for the slow growing cancer to be spotted via PET scan. I don’t feel your back to square one, looks like the majority of the cancer has been removed along with your Prostate. Hopefully radiating the Prostate bed will kill the cancer and that will be the end of it. Be sure the doctors protect your bladder and colon with the Spaceoar gel that blocks the radiation from damaging those two organs during your treatments.

Dave 3+4

Old Salt

I agree that you are not back at square one. A very large amount of cancer is gone. Now the aim is to eradicate the leftover. Hopefully it's all in the pelvic area, but as Vasco pointed out, that's by not certain.

I recommend getting a Pylarify PET scan. It seems to be more sensitive at low PSA levels, but you may have to wait, strangely enough, to do the scan at a somewhat higher PSA level than 0.19 ng/ml.