Biochemical reoccurrence

golfbuddy

Underwent a prostatectomy on 9/7/2022, pathology showed: adenocarcinoma, Gleason 7 (4+3); focal extraprostatic extension present (right anterior, right lateral), positive margin (left apical), involves 6-10% of prostate; 0/10 right pelvic, 0/5 left pelvic LNs involved; pT3aN0Mx.

PSA on first test was .07, second test 3 months later was .15

Radiation and ADT for 6 months. Other than tired earlier at night, no side effects. But I went to the gym 5 days every week lifting and biking

First two tests zero, then .07, .16 and last one .44. PET Scan showed nothing.

Some say just wait and keep testing PSA and new PET when > 1.00. Others say start intermittent ADT.

Any thoughts. If I did intermittent ADT, is 6 months on and 6 months off ok?

Thanks for your help

Clevelandguy

Hi,

Even though PET scans are very sensitive to small amounts of cancer sometimes you have to wait for the cancer to grow to be visible on a PET scan. Sounds to me like your Prostate cancer is reoccurring. I would think additional PET scans will be in your future until it can be detected by the scan, then attack it with some form of radiation treatment. Did your PSA go down while you were on ADT? Some survivors do several rounds of ADT, I would say additional rounds are up to you and your doctor team. ADT will not kill the cancer but only weaken it.

Dave 3+4

On_A_Journey

Hello @golfbuddy , welcome aboard. Our experiences are somewhat similar.

I had my prostatectomy in June 2015, Gleason 3+4, negative margins, but my first follow-up test showed my PSA at 0.53 and my next one was 0.75. I then had salvage radiation (33 doses) mainly in January 2016 but ADT wasn't even suggested! I didn't reach my PSA nadir of 0.04 until May 2018, and it has been climbing since. It is presently 0.74, with my next test due in October. I have had three PSMA PET scans - the first at 0.20 which is recurrence, the second at 0.38 and the third at 0.54. All were negative. I have known for a couple of years that if my cells aren't eventually detected, I face ADT, probably intermittently to begin with. I have my head around it now, just in case. I could have insisted that ADT start by now if I really wanted to, but I am happy to wait until my PSA reaches 1.0 now until my next scan, because I know that the chances of it picking up where the cells are, will be higher then.

I am led to believe that intermittent ADT treatment is typically 9 months on, and if your PSA has dropped to negligible levels during that time, stay off it until your PSA reaches a pre-determined level again. This could be years! You did the right thing keeping up with gym work and biking when you had ADT last time. From what I have learnt, it definitely helps.

If and when you do go back on to ADT, ask plenty of questions including ALL of the different drug options. There are first and second generation anti-androgens available as well as the traditional LHRH agonists such as Lupron or Zoladex or anti-agonists such as Firmagon or Orgovyx. Don't be scared to explore Estrogen as a treatment as well due to its minimal side effects apart from the physical ones.

Wheel

GolfBuddy,

I am staged as you pT3a, nothing in nodes. Initially I had positive margin reported when tissue sent to Pathology while I was on table. Surgeon then went further in prostate bed and cut more. Ultimately the final pathology report given to me post Op visit showed additional cuts had eliminated positive margin. My Gleason 8 was downgraded to unfavorable Gleason 7 (4+3). Due to being considered higher risk with Decipher, the surgeon mentioned adjuvant radiation and HT as something to be considered. I have thought a lot about that and for several reasons I am opposed until such time regardless if PSA is rising that the cancer is seen. Having cribriform pattern makes Radiation possibly less effective and lets just say its 50%, why would I want to subject myself to prophylactic radiation treatment that conceivably could not work do that not even knowing if its going to come back. Twenty years ago I was diagnosed with non-hodgkins lymphoma and after my chemo, three years later I relapsed. My local oncologist wanted me to be treated with a monoclonal antibody infused like chemo called Rituxan. He wanted me tweeted weekly for either six or eight weeks then go on Rituxan Maintenance therapy 4 weeks every 6 months for two years. This was a very accepted protocol coming into play. My other Oncologist from a teaching institute said don’t do it. Do just one 4 week course of Rituxan and if your cancer comes back then we will treat again. I have been in remission 16 years from that one treatment. Maintenance Rituxan to me is like adjuvant Radiation. You are treating something that may or may not be there and at some that treatment is having an effect on your body. Not even knowing with cribriform if it would work and not knowing if their is actually anything there, I will wait until its seen then treat.