Extreme PSA

agss241
agss241 Member Posts: 5
in Prostate Cancer #1

Was diagnosed 3 years ago with PC, had radiation therapy.  PSA after radiation was .5, 1 year later it was 2.4.  Recently had next follow-up, PSA is 37.5.  Doctor is going to schedule CAT scan and bone scan.  Don't quite know what to make of all this yet, wait until scans are done and next appt. with urologist is about the only thing we can do, I suppose.

Comments

  • Hondo
    Hondo Member Posts: 6,636 Member
    #2
    Prostate

    Sorry to hear that but please when you get the results please share them with us. I been avoiding getting my Prostate check because I have no insurance. Obamacare at $1,500.00 a month cost too much so nothing I can do for now.

     

    Tim

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #3
    Look for better image studies

    Agss241

    Welcome to the board.

    The increasing PSA confirms recurrence and its fast doubling is worrisome. I wonder your initial RT protocol.
    This time, the doctor will compare the image studies (CAT scan and bone scan) with previous ones to try locating any abnormality caused by a metastasis, which is thought to exist at the lymph nodes or bone (these are the potential places where cancer can cause fast doubling). If the exam is successful then you will have the opportunity to attack the cancer again with radiation, at those spots if these are found to be located in propitious areas. Such action could provide you cure.

    In any case, CAT scan and bone scan are not so effective in detecting cancer if the metastases are small in size (invisible). False negatives are common in PSA lower than 10.0 ng/ml. 3-T MRI exams have also some limitations but are better to locate the cancer. A Ga68 PSMA PET exam is at the present the most reliable exam in a case like yours with a PSA of 2.4 ng/ml (PSA>4 is better).
    If the CT and bone image studies are negative then doctors typically recommend palliative therapies with hormonal and chemo treatments.

    I think that you should discuss with the doctor on the above if you really want to make the best for your next therapy. I am not a doctor but in your shoes I would try the best (a PET exam) to locate the bandit before starting any palliative treatment.

    While waiting you can investigate about these exams and find hospitals doing those tests near to you. Here are links that may help you understanding the facts;

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843747/

    http://www.europeanurology.com/article/S0302-2838(15)00513-8/abstract/initial-experience-of-68ga-psma-pet-ct-imaging-in-high-risk-prostate-cancer-patients-prior-to-radical-prostatectomy

    http://info.blockimaging.com/bid/87030/3T-MRI-vs-1-5T-MRI

    http://www.stricklandscanner.org.uk/pro_mri_prostate.html

    http://www.europeanurology.com/article/S0302-2838(13)00824-5/pdf/hybrid-positron-emission-tomography-magnetic-resonance-imaging-with-gallium-68-prostate-specific-membrane-antigen-tracer-a-next-step-for-imaging-of-recurrent-prostate-cancer-preliminary-results

     

    You can also discuss with your doctor or try finding a clinic that has still open “seats” for the 68Ga-PSMA PET/CT clinical trial;

    https://clinicaltrials.gov/ct2/show/NCT02488070

    Best wishes and luck in your continuing journey.

    VGama

  • agss241
    agss241 Member Posts: 5
    #4
    VascodaGama said:

    Look for better image studies

    Agss241

    Welcome to the board.

    The increasing PSA confirms recurrence and its fast doubling is worrisome. I wonder your initial RT protocol.
    This time, the doctor will compare the image studies (CAT scan and bone scan) with previous ones to try locating any abnormality caused by a metastasis, which is thought to exist at the lymph nodes or bone (these are the potential places where cancer can cause fast doubling). If the exam is successful then you will have the opportunity to attack the cancer again with radiation, at those spots if these are found to be located in propitious areas. Such action could provide you cure.

    In any case, CAT scan and bone scan are not so effective in detecting cancer if the metastases are small in size (invisible). False negatives are common in PSA lower than 10.0 ng/ml. 3-T MRI exams have also some limitations but are better to locate the cancer. A Ga68 PSMA PET exam is at the present the most reliable exam in a case like yours with a PSA of 2.4 ng/ml (PSA>4 is better).
    If the CT and bone image studies are negative then doctors typically recommend palliative therapies with hormonal and chemo treatments.

    I think that you should discuss with the doctor on the above if you really want to make the best for your next therapy. I am not a doctor but in your shoes I would try the best (a PET exam) to locate the bandit before starting any palliative treatment.

    While waiting you can investigate about these exams and find hospitals doing those tests near to you. Here are links that may help you understanding the facts;

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843747/

    http://www.europeanurology.com/article/S0302-2838(15)00513-8/abstract/initial-experience-of-68ga-psma-pet-ct-imaging-in-high-risk-prostate-cancer-patients-prior-to-radical-prostatectomy

    http://info.blockimaging.com/bid/87030/3T-MRI-vs-1-5T-MRI

    http://www.stricklandscanner.org.uk/pro_mri_prostate.html

    http://www.europeanurology.com/article/S0302-2838(13)00824-5/pdf/hybrid-positron-emission-tomography-magnetic-resonance-imaging-with-gallium-68-prostate-specific-membrane-antigen-tracer-a-next-step-for-imaging-of-recurrent-prostate-cancer-preliminary-results

     

    You can also discuss with your doctor or try finding a clinic that has still open “seats” for the 68Ga-PSMA PET/CT clinical trial;

    https://clinicaltrials.gov/ct2/show/NCT02488070

    Best wishes and luck in your continuing journey.

    VGama

    Extreme PSA response

    Thank you for your seemingly knowledgable input and advice.  (I say "seemingly" simply because I have not as yet followed up on the links you so generously provided, but all you say makes sense and gives some purpose to what is to follow this week, please don't read anything into the word "seemingly").  CT scan and bone scan should be scheduled this week.  If Dr. Bradley has not called by this afternoon, we will call his office and get it moving.  I should think time is of the essence in a case like this.  It certainly is for my wife's peace of mind, the news from Dr. Bradley last week has her far more concerned than even I am.
    I'm going to follow up on the links you provided, knowledge is on the leading edge of the process of dealing with such things, even if the knowledge has some sort of undesireable returns, at least we'll have an understanding of what we're dealing with.
    Dr. Bradley did mention, in the follow-up before we had the PSA results, that if the PSA was elevated then hormonal treatment was a definite option. 
    Don't know how long results from the CT scan and bone scan will take, but we're anticipating knowing more later this week.  I'll post a follow up after the tests. 
    Thanks again.

    PS - I like your username, the name of an explorer and adventurer of his stature is most compelling in the current circumstances, as well as being somewhat auspicious.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #5
    agss241 said:

    Extreme PSA response

    Thank you for your seemingly knowledgable input and advice.  (I say "seemingly" simply because I have not as yet followed up on the links you so generously provided, but all you say makes sense and gives some purpose to what is to follow this week, please don't read anything into the word "seemingly").  CT scan and bone scan should be scheduled this week.  If Dr. Bradley has not called by this afternoon, we will call his office and get it moving.  I should think time is of the essence in a case like this.  It certainly is for my wife's peace of mind, the news from Dr. Bradley last week has her far more concerned than even I am.
    I'm going to follow up on the links you provided, knowledge is on the leading edge of the process of dealing with such things, even if the knowledge has some sort of undesireable returns, at least we'll have an understanding of what we're dealing with.
    Dr. Bradley did mention, in the follow-up before we had the PSA results, that if the PSA was elevated then hormonal treatment was a definite option. 
    Don't know how long results from the CT scan and bone scan will take, but we're anticipating knowing more later this week.  I'll post a follow up after the tests. 
    Thanks again.

    PS - I like your username, the name of an explorer and adventurer of his stature is most compelling in the current circumstances, as well as being somewhat auspicious.

    Suggestions

    To add, suggest that

    you ask the doctor to order a T3 MRI instead of the CT scan. If you click my name to the left, there is a short discussion about MRI

    You did not say what your doctors specialty is; but you want to have a Mecial Oncologist, the very best that you can find to lead your medical team, that  includse a radiation onocologist.

  • Old Salt
    Old Salt Member Posts: 1,530 Member
    #6
    hopeful and optimistic said:

    Suggestions

    To add, suggest that

    you ask the doctor to order a T3 MRI instead of the CT scan. If you click my name to the left, there is a short discussion about MRI

    You did not say what your doctors specialty is; but you want to have a Mecial Oncologist, the very best that you can find to lead your medical team, that  includse a radiation onocologist.

    I would also ask for the PSA test to be repeated. Mix-ups of samples and lab errors have been reported.

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #7
    hopeful and optimistic said:

    Suggestions

    To add, suggest that

    you ask the doctor to order a T3 MRI instead of the CT scan. If you click my name to the left, there is a short discussion about MRI

    You did not say what your doctors specialty is; but you want to have a Mecial Oncologist, the very best that you can find to lead your medical team, that  includse a radiation onocologist.

    add

    Also you may wish to investigate an advanced PET SCAn using a C11 Acetate. This test is not covered by insurance, and costs about $3,000. The test is given in Arizona.

    https://www.youtube.com/watch?v=WfzVi9mlMtM

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,819 Member
    #8
    agss241 said:

    Extreme PSA response

    Thank you for your seemingly knowledgable input and advice.  (I say "seemingly" simply because I have not as yet followed up on the links you so generously provided, but all you say makes sense and gives some purpose to what is to follow this week, please don't read anything into the word "seemingly").  CT scan and bone scan should be scheduled this week.  If Dr. Bradley has not called by this afternoon, we will call his office and get it moving.  I should think time is of the essence in a case like this.  It certainly is for my wife's peace of mind, the news from Dr. Bradley last week has her far more concerned than even I am.
    I'm going to follow up on the links you provided, knowledge is on the leading edge of the process of dealing with such things, even if the knowledge has some sort of undesireable returns, at least we'll have an understanding of what we're dealing with.
    Dr. Bradley did mention, in the follow-up before we had the PSA results, that if the PSA was elevated then hormonal treatment was a definite option. 
    Don't know how long results from the CT scan and bone scan will take, but we're anticipating knowing more later this week.  I'll post a follow up after the tests. 
    Thanks again.

    PS - I like your username, the name of an explorer and adventurer of his stature is most compelling in the current circumstances, as well as being somewhat auspicious.

    Numerous Responses

    ags,

    Unfortunately, "scans" are of less value with PCa than with most other cancers.  I learned this from my earier experiences with advanced lymphoma, before getting prostate cancer. A CT will not detect tumors smaller than around 4 or 5 mm, and metastatic PCa is often smaller in early stages.

    Vasco is correct: A PET Scan, which detects any form of "hypermetabolic activity," is to be preferred.  The bone scan you are receiving is reasonable.

    As Vasco also noted, your surge in PSA and its doubling rate is cause for concern and timely action.    I hope you are dealing now with a medical oncologist, which most urological oncologist are NOT.  Urologists tend to be HACKS when addressing serious relapses of first-line treatments.  You need to be treated with a MEDICAL ONCOLOGIST now.  What sort of radiation did you receive ?  

    Remaining treatment options consist of second-line radiation, Hormonal Therapy (HT), and beyond that, chemo. 

    Further Radiation Therapy, combined with HT, is potentially curative, based upon the specifics you have shared thus far. "Curative" means it is potentially still "curable."  "Pallative care," conversely, means treatments that will extend life potentially a long time, even decades, but which will not "cure" the PCa.

    max

     

    .

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #9
    Knowledge may lead to peace of mind

    Agss241

    I read again your initial post but this time I notice you have imputed the value of your last PSA to be 37.5 (ng/ml). Can you please correct me or did you change this value after my initial post?

    With this data your doubling becomes PSADT=5.8 months (with a velocity of 13.1 ng/ml/yr). This doubling is lower than the threshold PSADT of 14 months considered by most oncologists as the limit when judging aggressivity. Can you please tell us what type of carcinoma and Gleason was diagnosed initially?

    https://www.mskcc.org/nomograms/prostate/psa-doubling-time

    Aggressive type of cancers should be attacked “aggressively”. These are fast spreading bandits and have a tendency of creating colonies and growing in several places.
     Typically this cohort of patients get hormonal treatment with a total blockade protocols (ADT3) combined with an LHRH agonist, an antiandrogen and a 5-alfa reductase inhibitor(5-ARI). You can google for the details of those blockades typing each name.

    Please note that in this forum we are not the ultimate “experts” in the matters of PCa. Our “seemingly” knowledgeable is based on our own experience in dealing with the bandit, its treatments and the symptoms we have endured, and the researches we have done along our journeys. We are a bunch of survivors trying to help the many participating in this forum. You are most welcome to become another “seemingly” expert helping the many. (no heart feelings about the expression)

    I do understand your wife feelings. Our ladies provide the best support at these times of difficulty. PCa is in fact a family problem and we should try to involve them in all our decisions.

    I hope you get positive image studies so that you have a target to aim with salvage radiation. Probably in your doubling status the combined treatment (RT+HT) indicated by Hopeful above is the best attack.

    Best wishes, luck and peace of mind in your journey.

    VGama

     

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