PSA increased 16 months after Radical prostatectomy

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PSA increased 16 months after Radical prostatectomy

by Ralph66 on Thu Feb 21, 2019 03:11 AM

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Hi,

I am 53 years old now, PC G 4+5 diagnosed July 2017, PSA was 12 ng/mL just before the surgery which was done on September 2017.

First PSA post surgery was 0.03 ng/mL  (December 2017) and was consistently 0.03 ng/mL for (March 2018), (June 2018) and (October 2018).

Today (February 20, 2019)I did the test for 3 months follow up, and the PSA was 0.05 ng/mL.  Is this considered PSA duplication?  Does this mean biochemical recurrence?

What are the chances that salvage radiation will help cure this cancer recurrence?

Any advice is highly appreciated.

RE: PSA increased 16 months after Radical prostatectomy

by rjacks on Thu Feb 21, 2019 04:04 PM

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Not necessarily advice, but a similar experience at age 65. 2015 9.9, G(4+3) After surgery, <0.1, 7 mos. later 0.2 which was considered Boichemical recurrence. I opted for the salvage radiation and completed that, 3 mos later, 0.3. On a rise ever since. Even was involved in a drug trial study until just recently, cancer detected in the Lympth nodes made me ineligable for the study. Now looking at options, other than Hormone Theraphy, PSA, 20.1. Not sure about my next move. I know this doesn't help, but just an experience you can look at. Actually selfishly, writing this might have been good theraphy for me. Good luck.  

RE: PSA increased 16 months after Radical prostatectomy

by Ralph66 on Sat Feb 23, 2019 12:13 AM

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On Feb 21, 2019 4:04 PM rjacks wrote:

Not necessarily advice, but a similar experience at age 65. 2015 9.9, G(4+3) After surgery, <0.1, 7 mos. later 0.2 which was considered Boichemical recurrence. I opted for the salvage radiation and completed that, 3 mos later, 0.3. On a rise ever since. Even was involved in a drug trial study until just recently, cancer detected in the Lympth nodes made me ineligable for the study. Now looking at options, other than Hormone Theraphy, PSA, 20.1. Not sure about my next move. I know this doesn't help, but just an experience you can look at. Actually selfishly, writing this might have been good theraphy for me. Good luck.  

Hi,

Was your salvage radiation to the prostate bed only, or prostate bed PLUS pelvic lymph nodes?

Did they offer hormonal therapy together with salvage radiation to you?

RE: PSA increased 16 months after Radical prostatectomy

by Himads on Sun Feb 24, 2019 09:25 PM

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Hi Ralph66,

I have no specific recommendations. Just want to offer my support. I had a radical prostatectomy in May of 2018, so I am interested in this discussion. Best of luck to you and others dealing with this issue.

RE: PSA increased 16 months after Radical prostatectomy

by genemyers on Mon Feb 25, 2019 04:24 AM

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My first thought is that one psa reading does not tell you very much. I would get two more readings, one month apart; on March 20th  and April 20th  and look at the trend. Your one .05 might be a mistake. Do not wait 3 months for the next test.

Also you have a detectable psa after surgery so I assume your doctor has told you there is a chance that they left a small amount or normal prostate tissue behind that is creating the psa of .03.

If you do have a recurrence with a Gleason 9; the doctors are all over the board about what to do. Some will want to be aggressive with your treatment and give you radiation to the prostate bed plus the regional lymph nodes plus put you on Lupron. This is a shared decision on what to do between you and your doctor. My opinion is that you get to choose on what to do. Factoring into the decision is how extensive the cancer was from the surgery pathology report.

You might go to the Memorial Sloan Kettering web site and see what your chances of dying after RP failure by putting information into their nomogram. This might help you decide on treatment.

https://www.mskcc.org/nomograms/prostate

Your psa is to low, but if it rises to .1 or .2 I would look into getting one of the newer pet scans, the Axumin or Gallium, that will tell you where the cancer is. If you get radiation now it is radiation targeted to where they think the cancer might be; kind of a guess. Your doctor might order a bone scan and a ct scan, but these are likely to come back negative.

If you go on hormonal therapy and it fails there are good therapies available afterwards.

 

RE: PSA increased 16 months after Radical prostatectomy

by rjacks on Mon Feb 25, 2019 12:54 PM

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Yes, radiation was to the bed only (pathology indicated that cancer was not evident in the Lymph Nods at the time). Hormone therapy was not administered, and it's quite possible that I was not in favor of it at the time. They felt faily confident that the radiation was an adaquit response.

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