prostate cancer recurrence

waynebarry

10 years after prostatectomy the psa has gone from 0 to 0.4 (from 0.2 to 0.4 in last 6 months). The pet/ct test was negative. To be safe my urologist feels I should get radiation in the area where prostate was removed. He does caution about quality of life issues after the treatment. I am athletically active at 75. I am concerned about the incontinence. Please comment.

Clevelandguy

Hi,

If it was me first thing I would do is wait another 4-6 months and take another couple PSA tests over that time frame. This would tell you if your PSA is truly increasing or just hovering around a certain value. Second step would be another PSMA PET if your PSA increases. Third step would be a biopsy with around 20 total cores in all four quadrants looking for cancer. If that all turned out negative you could have Benign Prostate Hyperplasia(BPH) which will increase your PSA numbers. I would not do radiation until it was proven to me that cancer has been detected. In my humble opinion you need to find it to kill it. This is just my opinion of what I would do in a similar situation. I am not a doctor or do I play one on TV. Good luck…

Dave 3+4

Josephg

If I were in your shoes, I would not do radiation (or any other therapy), until the lesion can be identified on a subsequent PET scan. Your current cancer (if it was not just a skewed PSA test for some reason) was not seen in the PET scan, so you don't really know where it is.

centralPA

https://csn.cancer.org/discussion/comment/1714434#Comment_1714434

Since he had a prostatectomy 10 years ago, unless it is sitting in a freezer somewhere, they'll have a hard time biopsying it. 😉

I agree with the other posters. Better to wait for a signature of its location than to blindly blaze away with radiation.

Sorry your PSA is rising again. Ugh, must be disheartening to think it was completely behind you.

Clevelandguy

https://csn.cancer.org/discussion/comment/1714436#Comment_1714436

Hi,

Sorry, I had a brain fart……… 😂

Dave 3+4

jc5549

i’m sorry to hear you’re dealing with this. You would think 10 years after treatment that everything would be in the rearview mirror.

I’m attaching the most recent publication regarding recommendations for recurrent prostate cancer after initial therapy. Without knowing your primary risk factors, (Gleason grade group, margins, initial PSA…), it appears your main risk factor is the doubling time in six months, which has brought you to 0.4.

What a tough choice, what do you do in the face of a negative PSMA pet scan?

It may come down to your feelings about taking androgen ablation vs the risk of doing radiation alone if you pull the trigger now. Waiting for another few months may prove you to be high risk if your PSA velocity is sustained, which may put you in the ADT+XRT group. It sounds like you’re very healthy and follow up treatment at a 75 is reasonable. If your urinary continence is excellent and your urinary stream is good, you should weather a moderate to low-dose radiation field to the bed of your prostatectomy area fairly well.

Of course I’m saying this, as a member of the group, like you, that chose surgery to avoid radiation at all cost.

2024-salvage-therapy-for-prostate-cancer-aua-astro-suo-guideline-pa.pdf

Old Salt

Thanks jc; that summary paper (previous post) should be required reading for all facing this difficult decision.