Very slowly rising PSA 3.5 years after radical prostatectomy

WalterStevens · January 9

My surgery went well with really no incontinence issues 1 week post surgery. I have regularly tested PSA and my last several scores over the past year is outlined below. Prior to this I was and stayed in the 0.1 range, both above and below. They had not recommended a radiation oncologist consult until the 0.238 result in October. By the way, I had a PSMA/Pet Scan in May of 2023 and it showed no spread to lymph nodes or anywhere else.

Jan 2, 2023 0.222 ng/mL

Oct 24, 2023 0.238 ng/mL

May 8, 2023 0.229 ng/mL

Feb 7, 2023 0.168 ng/mL

Nov 29, 2022 0.178 ng/mL

The consult with a radiation oncologist occurred yesterday and they went straight to the following steps: 1) Placement of seeds, 2) Hormone therapy, and 3) radiation. This person shared a study that showed Pet scans are not always going to be accurate. No discussion of side effects (other than decreased libido with hormone therapy) with radiation.

I am trying to schedule another call with my oncology team (not the radiation team) to understand my options and what they recommend.

Frankly, I am struggling with what to do and how to make this decision. Any advice would be very helpful. Thank you.

Clevelandguy · January 9

Hi,

I am a little confused, why would the Oncologist recommend radioactive seeds and then also radiation or am I reading this wrong? Are they going to do the seeds 1st, then ADT, then radiation. Also you said the PET scan showed no spread to lymph nodes or anywhere else. So, where is the cancer? What areas are they planning to radiate?

Dave 3+4

Oldernow · January 9

Hi -

I am new to this site and joined today to learn and share my experiences with prostate cancer. I am confused too Clevelandguy. If you had a radical prostatectomy, where the heck are they going to put radioactive seeds??

WalterStevens · January 9

My understanding is that the "gold" seeds placed in the prostate bed gives them the ability to target the radiation. I was told hormone therapy would come after they started the radiation. Not sure what you mean by ADT?

Steve1961 · January 10

Uhmmm yes gold seeds Markers ..may want to peek at thisn

https://csn.cancer.org/home/leaving?allowTrusted=1&target=https%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3D%26esrc%3Ds%26source%3Dweb%26cd%3D%26ved%3D2ahUKEwjlgIKAhKOAAxW6m2oFHebnCNMQwqsBegQIEhAG%26url%3Dhttps%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253D-ZXDohxylg0%26usg%3DAOvVaw2YI7sJ0VG3QjqJ4p-w0qfm%26opi%3D89978449

Oldernow · January 10

https://csn.cancer.org/discussion/comment/1712172#Comment_1712172

ADT is Androgen Deprivation Therapy - I am on Lupron. Its goal is to remove the testosterone from your system since testosterone feeds cancer cells. Lupron comes with a variety of side effects - not a fun med.

Oldernow · January 10

https://csn.cancer.org/discussion/comment/1712172#Comment_1712172

also - gold seeds as fiduciary markers are NOT radioactive. They simply provide a target for the radiation (as you said)

Old Salt · January 10

I believe that what Walter called 'seeds' in his initial post should be referred to as fiducials. See his third post, if necessary.

Also, when Walter typed Jan 2, 2023, he probably meant Jan 2, 2024.

WalterStevens · January 10

https://csn.cancer.org/discussion/comment/1712179#Comment_1712179

I'm sure you are right. The radiation oncologist referred to them as seeds.

WalterStevens · January 10

https://csn.cancer.org/discussion/comment/1712179#Comment_1712179

You're right. 2024

centralPA · January 10

https://csn.cancer.org/discussion/comment/1712180#Comment_1712180

Makes sense that they would be markers, but I did some googling on brachytherapy as a salvage treatment for failed RALPs, and it is a thing, especially for “palpable nodes”. Both LDR and HDR. I don’t know where the radiation would be placed. Example…

“https://www.brachyjournal.com/article/S1538-4721(22)00386-5/fulltext”

Steve1961 · January 10

take a peek at this

https://csn.cancer.org/home/leaving?allowTrusted=1&target=https%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3D%26esrc%3Ds%26source%3Dweb%26cd%3D%26ved%3D2ahUKEwjlgIKAhKOAAxW6m2oFHebnCNMQwqsBegQIEhAG%26url%3Dhttps%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253D-ZXDohxylg0%26usg%3DAOvVaw2YI7sJ0VG3QjqJ4p-w0qfm%26opi%3D89978449

WalterStevens · January 10

https://csn.cancer.org/discussion/comment/1712175#Comment_1712175

I must have missed it. At what minute is it mentioned?

Very slowly rising PSA 3.5 years after radical prostatectomy

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