Immediate PSA rise after rad prostatectomy and salvage radiation

brooksgnm

Hello. I completed salvage radiation on Jan 29 of this year and rather than going down from .226 when I began the IMRT radiation, the PSA went up to .503 when checked on April 14. Does this mean complete failure of the radiation treatments? I have not had any androgen therapy, just the prostatectomy. My PSA was 0 after surgery but began to go up about 8 months after surgery. Gleason 9, pT3b, no lymph nodes, no positive margins, but seminal vesicle invasion. I cannot find anything on line other than it can take awhile for the radiation to work.. Thanks, Gary

J69

Brooks, I am not a doctor, but I’m surprised you haven’t started ADT yet. I only had IMRT for my GL-8, but my urologists immediately put me on ADT. I would think by now your PSA should have decreased not gone up, although for some it does take up to six months after radiation to see results. I would get with your Uro and see about adding ADT. Again, I am not a doctor.

brooksgnm

Thanks for the comment., How have your side effects been from the ADT? Both myself and my urologist were not anxious to begin it until we see what effect the radiation had. He considers ADT palliative care, meaning it is not a cure, just knocks it back for a bit.

Old Salt

Sad to say, but it appears that your cancer had metastasized, perhaps even before the surgery.

Presumably there were scans before the surgery; what did they show (or not show)?

Any scans after the surgery, prior to the radiation?

I would recommend discussing a PMSA scan with a medical oncologist. If a cancerous locus can be identified, perhaps it can be irradiated. But there is little doubt in my mind that you will also need some sort of ADT, or chemo.

brooksgnm

Thanks for the reply. The scans before surgery were negative but from what I understand they are not very definitive. A couple of questions, what is a PSMA scan and can it detect a very small metastasis, and is there a difference between my urologist and a medical oncologist? Which one specializes in delivery of the ADT? Gary

Old Salt

PSMA = Prostate Specific Membrane Antigen.

Pylarify is one example of this kind of scan and it is available at many locations. It is supposed to be (!) the most sensitive scan approved and currently available.

PYLARIFY® | Prostate Cancer Diagnostic Imaging Agent

With all due respect to your urologist, you should transfer your care to a medical oncologist ASAP. (S)he should be on top of situations such as yours and aware of the latest developments for metastatic disease. You could also consult with an academic center of excellence. If in the USA:

NCI-Designated Cancer Centers - National Cancer Institute

Good luck!

brooksgnm

Thanks, I see my urologist and radiation onc this week, and most probably will be looking for the right medical oncologist after that. Gary

J69

Gary, I have serious doubts about what your Uro is saying. You had surgery and you are a GL-9. You had salvage radiation because the surgery failed to get all the cancer. Yes, you can wait to see how the radiation effects your PSA, but more than likely your cancer is aggressive with a GL-9 and ADT is in you future now or later. Your Uro says that ADT is just palliative care? Palliative care is in my opinion reserved for those where all other treatments have failed. I know of several PC survivors that have been on ADT for over a decade and are doing just fine. So I agree with Old salt, find a good MO and get on a program that can help you survive this disease. Your Uro is the one that will provide the ADT. As far SEs from ADT. Some weight gain which you can control by exercise and a better diet. Some day and night sweats that can be controlled somewhat by staying cool. And lack of libido, which depending on what libido you currently have after surgery is a personal thing. Here is my thinking on ADT, put up with the SEs or die sooner. To me not a hard choice. Keep in touch. I would also recommend other forums where there are many GL-9 diagnosed men reporting on what treatments they have had and what SEs they have had. Keep a positive attitude and continue to fight.

brooksgnm

Thanks, Could be my misinterpretation of the "palliative care", but pretty sure he said that the ADT was my last option, and it eventually fails. So, if the radiation did not work, I will need to do it. Please help me understand the roles of the MO vs the Uro....why would the Uro do the ADT if I am seeking a MO? Why not wait to see the MO and let him decide which drugs/ course of action would be best? Thanks a lot...it helps just talking to others about it. Gary

J69

Gary, the Uro can prescribe the ADT until you get a MO. The MO will then decide what is best for your situation. If you are actively seeking a MO you can wait to see what he or she wants. Uros treat the urinary tract issues and do the surgery. In more advanced cases the MO decides what treatments such as ADT, chemo and palliative care are needed. Again there are many treatment options including more radiation if needed down the road. It would seem like he wants you to wait to see how the radiation works before prescribing ADT. Not knowing all the factors like, clean margins, lymph node involvement, and results of scans it is hard to know what is best for you. But with a PSA over .500 after radiation most would be on ADT. I am surprised your RO didn’t suggest it. There is a forum at Healingwell.com under prostate cancer that has many GL-9s that are going through what you are facing. My best to you

JP63

I dont know with radiation salvage therapy but I read somewhere that at least with radiation the first time the Psa may go up and down until it stabilizes.

centralPA

It sure sounds like the cancer was not where the radiation went. Once your prostate is gone and the cancer stays, it is likely on a walkabout well away from a Urologist's normal turf, but in the medical oncologist's sweet spot. Ideally, an MO that works prostate cancer a lot. You can wrestle this down...best of luck Brooks!

brooksgnm

Thanks to all who replied. Saw my urologist and radiation onc yesterday. Both said the radiation has probably failed because the cancer has gone to places other that the prostate bed, and that I would need to begin hormone therapy. They have referred me to a medical oncologist and for a PSMA scan. There was mention of a new drug called Orgovyx (?) that you can take orally. Gary

J69

Gary, it is great that you are getting on top of this disease. I have been on the Healingwell site with your questions. I have also emailed a veteran who has great knowledge in this area. All agree that you need a MO, to guide your next steps. There are many on the Healingwell.com site that have had failed surgery and failed salvage radiation and have lived a long life. But you have to act quickly. I am on Orgovyx. It is one pill a day for whatever the duration the doctor decides. It can be expensive, but usually there is a representative that can help bring the price down. I pay $40.00 a month and I am on it for 18 months. The SEs are what I described in a previous post. Check out the Healingwell site as there are many there that will respond to any questions you may have. My best to you.