ALL SCANS CAME BACK NEGATIVE BUT PSA IS 2.3?

Coachmark8

Hello everyone

Im 70 years old - had prostate cancer surgery in 2010 - for the next 9 years my PSA was fine <1 - in 2019 it was 1,0. Then this year (August, 2021) my PSA went up to 2.3. Ive had 3 scans since August - a bone scan and a CT scan and a PET scan using tracers. I even had a UTI test for possible bladder infections. That too came back fine - negative results.

If you were me, would you consider radiation at this point even though they couldnt find any cancer? My doctor is recommending i speak to Radiation Oncology people. Thanks.

Josephg

If it were me, and I was having no symptoms that may be related to PCA, I'd wait longer and see if the next PET scan can locate the source of the PCa. Taking radiation therapy when not knowing where the PCa is actually located, equates to shooting in the dark with the hope of zapping the bandit. There are definite side effects that will become apparent after radiation, if it were me, I would not want to incur those side effects, unless I was quite confident that they were radiating the area where they 'knew' that the PCa was located in.

Coachmark8

https://csn.cancer.org/discussion/comment/1691131#Comment_1691131

Good morning Josephg - I tend to agree with you - the idea of approving them zapping me with radiation at this point - NOT knowing where PC is - makes little sense. I DO understand that its always great IF they can treat you at a very early stage if you have cancer. Obviously that would be the ideal scenerio. BUT that said, im leaning against getting the radiation treatments. I have an on line virtual appointment on Dec 16 with Radiation Oncology doctor who i think will discuss the pros and cons of getting radiation now. Ill keep you posted/ Thanks for taking the time to chime in. Have a good day.

Josephg

https://csn.cancer.org/discussion/comment/1691132#Comment_1691132

I don't know what your current PCa medical team is comprised of, but if there is not a Medical Oncologist on your PCa medical team, I strongly recommend that you consider engaging one.

A Medical Oncologist has no professional preference for potential treatment options, such as surgery or radiation, and the Medical Oncologist is the expert in hormone therapies, which may be used in conjunction with other treatments, such as radiation. Personally, I've had PCa for over a decade, and my Medical Oncologist has been at my side for my entire PCa journey. Surgeons and Radiation Oncologists have come and gone with their treatments, at the direction of my Medical Oncologist, but my Medical Oncologist remains my sustaining medical professional and consultant.

Coachmark8

My current PC "medical team" doesnt exist - i simply have a Urologist who referred me to Radiology Department - and they will call me on Dec 16 in a virtual meeting to discuss pros and cons of getting radiation treatment. Thats it - there is NO "Team" - Its 1 Urologist. (He actually was the surgeon who removed my prostate back in 2010)

Coachmark8

PS. Im confused to be honest - 3 scans and NO PC found? Now they are referring me to Radiology Department for possible radiation and/or hormone treatments. How much money do you think all these tests and scans cost? Who pays for this/? Its one referral after another with no PC found.

Cancer is BIG business and you can see why in this case. People make money - lots of money - with cancer.

I am leaning towards NOT getting radiation treatment at this time. Maybe down the road.

Josephg

https://csn.cancer.org/discussion/comment/1691135#Comment_1691135

Then, I will make an even stronger recommendation that you engage a Medical Oncologist, and have this person be your point of contact and primary consultant for the remainder of your PCa journey. No disrespect meant, but you are now past the time for your Urologist to be your point of contact. Any medical group or hospital system that has a cancer treatment staff will have one or more Medical Oncologists on staff.

In my personal case, after my Urologist performed the biopsy and reviewed the results with me, which confirmed that I had PCa, I then sought out a Medical Oncologist and started my PCa journey.

Coachmark8

https://csn.cancer.org/discussion/comment/1691136#Comment_1691136

Since Radiology Oncologist WILL be calling me on Dec 16 - ill wait and see what im told - pros and cons of getting radiation treatment. Thanks for your suggestions.

Clevelandguy

Hi,

If you can’t determine where your cancer is located, then what area would you radiate? If it was me I would wait for some hot spots to show up a on a MRI or PET scan before radiation treatments begin. Prostate cancer cells typically are not a very fast growing type or cancer so you should have time for your cancer to show it’s ugly head and still be able to kill it with radiation. You have got to find it to kill it.

Dave 3+4

Old Salt

You should tell us more precisely what kind of scans you got.

There's a relatively new PET scan (Pylarify) that seems to be good at finding hot spots at relatively low PSA levels. Its target is PSMA. In your shoes, I would insist on getting that one, even if you had to travel to get it.

PYLARIFY - Lantheus

Coachmark8

https://csn.cancer.org/discussion/comment/1691154#Comment_1691154

Hello - i had a CT scan - a bone scan - a PET scan using tracers - (I was told the PET scan they used was "state of the art" - best one available) - IM waiting for a copy of the PET scan report/summary - i didnt get a copy yet - my Urologist called me and gave me the news that the PET scan was negative. Thanks for your input.

Old Salt

Please post your PET report once you get it (without your name of course) and we can try to comment.

Coachmark8

https://csn.cancer.org/discussion/comment/1691177#Comment_1691177

ok - i see the report was mailed to me - i will get it today and post it etc etc - minus my name - thanks

VascodaGama

3 scans and NO PC found? 

Yes, that is awkward if we judge the last PSA in being correct. I wonder about the type of the cancerous cells found at your initial diagnosis of 2010. Can you tell us what was, at the time, the Gleason score, number of positive cores and PSA histology?

Regarding the state-of-art PET scan capabilities, these are subjected to the the type of isotope used to identify malignancy, timing of the picture session and location of the metastasis.

PSMA isotopes are the most appropriate for prostate cancer but the radio-tracer (F18, 68Ga, Lu177, etc) outcome differ on the location where the bandit is hiding. In my case (PSA 2.0 ng/ml), F18-Choline PET was positive identifying PCa at the prostate bed plus one deep lymph node of difficult access, but the 68Ga PSMA-PET was considered negative because the image at the prostate bed was blurred due to urine excretion (bladder filled with the tracer) and no lymph involved.

I believe that in localized recurrence cases the F18-PSMA radiopharmaceutical is the best choice. F18 has longer half-life allowing longer and timely sessions of picture taking which avoids the problem of tracer excretion via the bladder, and therefore the blurring seen in 68Ga-PSMA PET.

Though the PSA is high (if correct), I think you doing well in waiting for a more precise location of the bandit. Radiation works well at higher PSA levels but badly if the target is not the correct one.

I recommend you to repeat the PSA test every three months, adding a testosterone test in case you will require ADT in your future sequential therapy.

Best wishes,

VGama

Coachmark8

Many thanks - God Bless You!