PSA now present first time 9 yrs after radical prostatectomy

squash05

Robotic prostatectomy in 2015; PSA 14, Gleason 4-3, no lymph or seminal vesicle involvement, clean PET scan. Serial blood tests every year no PSA detected. In 2023 PSA 0.1, this year 0.44. Haven't had urology consult yet. Looking for comments from others who had an uneventful course for years, then raising PSA. What treatment and how did things turn out. After 9 yrs, thought I was done thinking about this ****!! Thanks in advance

On_A_Journey

Hi there @squash05, welcome aboard.

I also had my surgery in 2015 and had to follow it up with salvage radiation 6 months later. My PSA didn't bottom out until mid 2018. It got down to 0.04 but has been going up slowly ever since. It is presently at 0.67 but I am not receiving any treatment for it yet. I have PSA blood tests and consultations with my oncologist every three months. In other words, I am still at the active surveillance stage of my 'biochemical recurrence' journey. Despite our different situations, where for the most part I have had some background PSA activity going on since my surgery, our paths ahead might be similar.

I'm thinking that when you do have your appointment, he or she will suggest a follow-up blood test in another three months which will confirm the trend of your increasing PSA. Due to its velocity, you might be up for a PSMA PET scan soon after that to detect where the cells are. If they are detected but still around the prostate bed, you will more than likely get radiation to that area, possibly with hormone therapy at the same time, in an effort to slay the bandit once and for all.

The last time I had a PET scan, in February 2023, my PSA was 0.57 and nothing was detected. The chances of detection increase with PSA, so in my case, I will wait until it gets to 1.0 or so before having another one. But, I understand your concern with your PSA, which seems to be rising quite rapidly, coupled with your original 4+3 score (mine was 3+4).

Just bear in mind that biochemical recurrence occurs in about 1/3 of those who undergo radical prostatectomies, at any stage in their futures. What you are experiencing, although disappointing, is actually not that unusual.

Keep your chin up!

Wheel

Squash05,

As mentioned earlier Keep your chin up! A lot of advances in treatments in the last 10 years. Even scans are around today that were not then MpMRI’s , PSMA Pet’s. , Genomic testing. For certain newly diagnosed patients Active Surveillance is the initial course, which was not the standard protocol for many in the past. I had non Hodgkin’s lymphoma years before my prostate cancer and initially had chemotherapy and years later when I relapsed their was a newer less toxic 2nd line treatment. I had that treatment and in remission on that cancer until the new beast hit. I imagine they will want to do a Pet Scan to see if they can identify a target for radiation. They are now looking at PSA driven treatment versus Image driven treatment for Bio Chemical relapse all due to the advances in imaging with the PSMA Pet. In the past again once your PSA reached .2 you were biochemical relapse and wanted you to start radiation. Now people are waiting with the number going much higher to 1 before treatment as studies are starting to show no change in life expectancy outcomes from PSA driven to image driven. Image driven gives s target for the radiation. As when you were first diagnosed don’t hesitate to get second opinions and go to major cancer centers if close by.

Clevelandguy

Hi,

If it was me I would keep doing the PMSA PET scans until something shows up, then as Wheel said attack it with radiation. Even if radiation fails next line of defense would be Proton treatments which can be used when radiation has failed. Your doctors might want to include some ADT drugs before or after your radiation. ADT drugs can be kinda rough on you, but there are several out on the market to try. Good luck……

Dave 3+4

Marlon

Thanks for reporting your situation. I too would have hoped it was gone after all that time. What I understand that wherever and whatever is there, it has to be big enough they can see and target it.

Josephg

I'm sorry to read about your recurrence. I learned a long time ago to use the term remission for PCa (or any other cancer for that matter), instead of the term cure. I also adopted mental mindset that PCa is a journey, and not an occurrence, and I learned that from members of this Discussion Board, some of which are no longer with us here. It adjusted my thought process and expectations regarding PCa in my life. When I had recurrences, I was disappointed for sure, but I was not completely shocked, nor did I go into a panic over the new diagnosis. I saw it as just another milestone in my PCa journey.

On a similar note, a good friend of mine, who I met 10 years ago when we were undergoing IMRT, PCa for me and breast cancer for her, was just advised that she has a recurrence of her breast cancer after 10 years, and will need to undergo a radical mastectomy.

You have received some good advice above, regarding the next steps. I followed that same advice from this Discussion Board during my recurrences, and let the PET scan results serve as the foundation for assessing any next steps for subsequent treatments.

I wish you the best of outcomes on your PCa journey.

squash05

Thank you brothers for the input and sage advice. Just another bump in the road!

murphmarl89

Squash5, looks like I am in the same boat as you. Removed in June 2019, PSA good until 16 months ago, .1 to .4 in about 2 years. Working with primary doctor and now making an appointment to see my cancer doctor to see where that takes me. I got good info here, Thanks everyone.