Recently diagnosed with Gleason score of 9

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  • SV
    SV Member Posts: 183 Member
    edited May 2021 #202
    Josephg said:

    SRBT

    SV,

    I recently underwent SRBT for a PCa lesion in my pelvic bone.  I had 3 treatments, totalling 30 Grays.  Side effects were almost non-existent, having only some slight tiredness about 1 week after the 3rd treatment, and this slight tiredness lasted about 1 week.

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

    Thanks. Did they put you on

    Thanks. Did they put you on Lupron?

  • SV
    SV Member Posts: 183 Member
    #203
    Modest Rising PSA

    I'm currently at UCLA undergoing three treatments of SBRT for the recently detected rapidly doubling PSA. (microscopic lesion in pubic bone revealed in PSMA scan) But my most recent PSA test indicates that the PSA rise has now dramaticaly slowed.

    1. I realize that the PSA rise can fluctuate but is this much slowing normal?

    2. If my PSA slowed to a crawl would it have even been necessary to treat?

    3. Could my bodies immune system have eventually killed the cancer?

      1/7/202/14/209/16/2012/8/20  12/8/20    3/10/21     4/6/21        4/28/21       5/18/21 
    Total PSA
    <=3.101 ng/mL

    		 1.950 0.180 <0.008 <0.008 <0.008 0.130 0.290 0.390 0.440

     

     

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #204
    How about symptoms?

    Yes, it is too early to consider an opinion. Can you please paste here the report on the PSMA-PET exam (some images would be better). I wonder if they detected any deep lymph node invasion. Those located in the areas behind the bladder/ureters hard to be identified due to blurred image (a cause typical in excretion of the contrast).

    Let's hope for the best.

    VG

  • SV
    SV Member Posts: 183 Member
    #205
    Thanks guys

    Those PSA test results were from before radiation. I wanted a more precise baseline so had that last PSA test done the day before radiation. I just finished my three-day SBRT treatments yesterday. I'll get tested again in another month. I am still curious about the same issue regarding the PSA testing done prior to radiation:

    1. I realize that the PSA rise can fluctuate but is this much slowing normal, as in good news?

    2. If my PSA slowed to a crawl would it have even been necessary to treat?

    3. Could my bodies immune system have eventually killed the cancer without radiation?

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #206
    Thanks for the report

    Hi again,

    I received your mail. Accordingly, apart from the spot on bone (recently treated by SBRT) all other findings were negative.  In any case, I think that the PSA was quite low (less than 0.1 ng/ml) which may not be proper for  a PSMA PET. You risked false negatives, however,  the exam lasted 99 minutes since injection which could balance for the lack of prostatic cells activity. The PSMA ligand is supposed to "react" in prostatic cells but some do not react that much to the membrane antigen so, a higher PSA could assure a higher efficacy of this exam.

    I think you are caring well your PCa case. The facilities you use ant team of doctors are also super. Let's hope that the SBRT is successful and gives you peace of mind. 

    I will wait for your next report. 

    Best

    VG

  • SV
    SV Member Posts: 183 Member
    #207
    Distressing news again

    I had the SBRT treatment a month ago and my PSA did not decline as hoped. Instead it continued to rise from .440 to .540. Am I expecting too much too soon or is this normal?

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,817 Member
    edited June 2021 #208
    SV said:

    Distressing news again

    I had the SBRT treatment a month ago and my PSA did not decline as hoped. Instead it continued to rise from .440 to .540. Am I expecting too much too soon or is this normal?

    Maybe....

    SV,

    Radiation therapy routinely causes a reaction known as "PSA Bounce," in which a man's numbers will go up for a time, even if the treatment was wholly successful.   It sounds to me like you will need to wait on a new nadir  (lowest equilibrium).   Ask you doctors, but that is likely what is going on.

  • Old Salt
    Old Salt Member Posts: 1,504 Member
    edited June 2021 #209
    Patience!

    Yes, too much too soon.

    It's too early to come to a conclusion. The radiation causes cells to die, but this takes time. 

    I believe that your first 'data' point should be at three months.

  • SV
    SV Member Posts: 183 Member
    edited August 2021 #210
    PSA continues to climb

    I had my second 30-day post-radiation PSA test and it continues to rise going from .440 the day before radiation to .540 a month later and now a month later to .680

    This was radiation given to small bone lesion in the pelvic area pubic bone. Shouldn't there be some kind of PSA decline 60 days after radiation? Do bone mets react slower to radiation than lympth nodes?

    TOTALPSA 0.680 07/29/2021
    TOTALPSA 0.540 06/21/2021
    TOTALPSA 0.440 05/18/2021
    TOTALPSA 0.390 04/28/2021
    TOTALPSA 0.290 04/06/2021
    TOTALPSA 0.130 03/10/2021
    TOTALPSA <0.008 12/08/2020

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #211
    Systemic treatment

    SV,

    This constant increase is called biochemical failure. This is followed by the status of recurrence which leads to some sort of intervention. Typically doctors use a certain value of the PSA as their threshold to start a therapy. In your case I think it would mean a return to ADT. Though the PSA is small the doubling PSAdt is close to less than 6 months which justify an earlier start. 

    In any case, if in your shoes, before ADT I would allow the PSA to increase further to a value of 2.0 ng/ml and get another scan (probably this time the F18-PSMA), deciding then what to do. 

    The bandit may be in deep lymph nodes in which ADT can stop progression but not eliminate it. Spot radiation would be the best choice if it is found to  lay at a convenient place.

    At some USA hospitals they have been running a clinical trial with this new stealthy therapy using radiation sort of missiles named Lu177-PSMA which is a radiation treatment for systemic cases. You may discuss the matter with your radiotherapist.

    Here are some reading materials;

    https://www.clinicaltrials.gov/ct2/show/NCT03828838

    https://csn.cancer.org/node/323698

    Best

    VG

  • Old Salt
    Old Salt Member Posts: 1,504 Member
    #212
    It's complicated, but

    Too many variables for somewhat solid conclusions.

  • Old Salt
    Old Salt Member Posts: 1,504 Member
    edited August 2021 #213
    Unfortunately

    I have to agree with Vasco's assessment.

    Although I was hoping that your PSA would go down after some more time (see my 6/24 post), it looks like this is not happening.

    Consequently, we must assume that cancer foci are hiding elsewhere as well; not just in the pubic bone. Hormone therapy (ADT) may well be in your near future. Exactly when to start ADT (right now or waiting for it to rise above a certain level) should be discussed with a medical oncologist (or two).

    What do the UCLA docs recommend?

     

  • SV
    SV Member Posts: 183 Member
    #214
    Thanks amigos

    I was hoping that maybe the SBRT was needing more time to work because it is in the bone but after seeing my PSA rise two months in a row after being treated my optimism is fading. Docs at UCLA say to wait for the third PSA test to what happened. If my PSA does continue to rise then they would order another PSMA scan and then act on that.

    I was curious though...if a PSMA scan might pick up other kinds of cancer?

  • SV
    SV Member Posts: 183 Member
    edited August 2021 #215
    Ugh news

    Did a telemed with head of UCLA RO today. Assumes a new tumor is growing somewhere. Will do another psma scan in two months if the PSA is still rising and then radiate again.

  • SV
    SV Member Posts: 183 Member
    edited October 2021 #216
    Damn!

    PSA test results just jumped from .68 to 2.7 in only two months. Also experiencing lower back pain. Trying to get an appointment for a PSMA scan but there is a waitlist. I'm guessing Dr will want to get me on ADT asap but I'll have to wait until after the scan otherwise tumor will be less visible. Anyone have thoughts on this?

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #217
    Therapy should follow a strategic plan based on the scan result

    Yes amigo,

    I think it better to start ADT only after the scan. The PSA can be controlled at anytime independently of its level, even if it doubles while waiting for the scan results. 

    The fast rise may signify that lynthnode (s) are involved. The F18-PSMA pet is good to check those deep areas. Discuss the details with your doctor and decide on the next steps/therapy once you feel comfortable with his proposal. 

    Best.

    VG 

  • SV
    SV Member Posts: 183 Member
    #218
    Thanks amigo...

    Due to a last minute cancellation, I was able to get a PSMA scan scheduled for Monday, October 18, 2021 at UCLA. But I also have a PET scan at another facility scheduled for Friday October 22, 2021. I realize that the PSMA is far more sensitive than the PET but I've also heard that sometimes the PET scan will reveal certain micro-tumors not picked up by PSMA. My question is, after I get the PSMA, should I go ahead with the PET also? Both scans appeared to be covered by Medicare.

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #219
    Half-life of isotopes needs consideration

    Surely two image studies (multiparametric) will help the radiologist's conclusion on findings. However the body should be clean by the time of the picture session unless the isotopes (tracers) used in the scans are from similar substances. Isotopes using the antigen PSMA (68Ga-PSMA PET,  F18 PSMA-PET) are specific to prostatic cells (the bandit). Isotopes using fluciclovine (Axumin F18-PET) are specific to cells in a rapid growth status like cancer producing loads of amino acids. The substance that glares (the radio tracer) makes the difference and produces a different image helping in the interpretation of the film. The most used in PET imaginery of cancer are the 68-Gallium and F18 fluorine. These substances have different half-life (in hours of activity) but any residual could interfere and cause errors. You need to discuss the matter with the radiologist and schedule the time of the scan properly.

    The time and date of the scan needs to be set in advance because of the capabilities in producing the isotope. 68Ga  can be produced in a common generator locally but F18 (better for your case) needs to be produced in a cyclotron available at nuclear facilities which needs to be retrieved timely coinciding with the time of the scan. 

    PET is the machine that takes the pictures and is the best for cellular examination (at microscopic cells level). Both exams should be done with PET/CT or PET/MRI equipment. 

    Wishing you a successful finding. 

    VG 

  • SV
    SV Member Posts: 183 Member
    edited October 2021 #220
    I had the PSMA scan done

    I had the PSMA scan done today at UCLA and they mentioned that their Isotope was prodcued in a cyclotron acroos the campus. My PET scan is scheduled for this Friday (5 days later). Do you think that is enough time to clear out whatever they injected me with today?

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    edited October 2021 #221
    Call the clinic in advance and inquire on the possibility

    What did they "injected" you?

    What are the specifics of the scan?

    Was it a 68Ga-PSMA?

    What are they going to "injecting" you this Friday?

    What are the specifics of Friday's exam?

    You should call and inquire the clinic where you will get the exam.

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