What Next?

jfdugan2

I would appreciate your thoughts and insights on what I might expect:

I am a 78 year old who was diagnosed in 2022 with a Gleason score of 8/9. Put on hormone therapy, which lasted for 18 months. Bone scan was clear but lymph nodes were involved. Radiation treatment – 26 in August/September 2022. PSA was almost indictable after this but since has started going up. I am tested (with a blood test) every six months for PSA and the last two tests have seen a doubling or more of the PSA – still low at 1.0.

My question has to do with at what point should I be concerned that the cancer has reactivated? Will a PSA test tell the tale? If the cancer is active again, is another round of radiation in the cards?

VascodaGama

Hi again,

Typically, the PSA indicating recurrence in RT patients is a value above NADIR + 2.

In your case, that would be a PSA above 2.43, because you had a PSA of 0.43 in 2022 after treatment.

However, your case has been identified as risky for the Gleason 9 and affected lymph nodes with PCa, which may require additional treatment. I wonder what's the opinion of your doctor.

You also said before that RT was 26 sessions. This is a low number if the intervention was IMRT. Probably the radiation aimed the lymph nodes and some parts of the gland only.

In any case, radiation over radiation is never recommended. You may discuss with your radiotherapist if you could do spot radiation at areas of metastases identified via a PSMA PET exam.

Best

VG

Steve1961

most likely continuing hormone treatments to keep psa in check..speaking from experience from a 62 year old friend with same gleason score and node involvement ..dont know what kind of physical health you are in but dr robert reiter at ucla can detect exactly what nodes are involved and remove them thry radio guided surgery..look him up on yuotube

Clevelandguy

Hi,

You can use Proton beam radiation where you have maxed out typical external beam x ray based radiation. Check with your Oncologist to see if Proton is available nearby.

Dave 3+4