Postop PSA doubled in 4 weeks

Im 7 months postop RALP....1st postop Psa was 0.01, then 0.06 4 weeks ago which was repeated Friday. Got result today of 0.13....not my lucky #. Im having repeat CT and bone scan this Friday and will talk to several Rad Oncs soon. Radiation and/or HT in my future I believe.
Scott

I am sure that's not what you wanted to hear. Does sound like you've got more treatments coming up. HT at least I would think but at G9 don't be surprised if it is 'and' not 'or'

Let us know what happens with the bone scan.

All the best for a good outcome.
Andrew

Hi Scott,

Sorry to hear the news. I recently had IMRT therapy after recurrence following failed RRP. In my case, with positive margins, my doctors advised adjuvant RT, but I held off until my PSA at least rose above undetectable. It went well, even though I elected for whole-pelvic radiation to hit the pelvic lymph nodes as well.

I had hoped the Sloan-Kettering SRT nomogram would be of some help for my decision-making nomograms.mskcc.org/Prostate/SalvageRadiationTherapy.aspx, but it isn't calibrated for numbers under .1, so I couldn't hope for anything but wild guesses. Plus, I had insufficient data to calculate PSA doubling time. Since your PSA has topped .1, perhaps you will find it useful, although I'm not sure many doctors would be happy calculating doubling time from any values below .1.

I hope you find great doctors who can help find the best treatment path for you.

Nellie

Scott,

G 4+5 here - I did adjuvant IGRT, but just because of EPE / Positive margins. My uro does not do ultrasensitive, so in theory I was undetectable, but it has come roaring back here lately.

I'll agree with the incontinence comment above - my improvement stopped, and I actually got a little worse with RT.

My day to day "journey" with RT is linked in my signature below.

I have seen 2 radiation oncologist so far...one advised radiation of prostate bed and nodes along with HT. The other just prostate bed radiation without HT. I am leaning towards just radiation at this point....I dread the HT effects more. I have a 3rd consult Thursday so we will see how the second 2nd opinion goes :)
Scott

Hi Scott,

Studies show that HT when combined with RT substantially improves survivability. So you have to balance relative risk. Do you endure the unpleasant side effects of HT, or take the risk that you'll be in the lucky group who don't recur despite not having HT. When faced with that choice, I personally decided I'd much prefer some hot flashes, low libido and fatigue to the increased chances for something much, much worse.

Best wishes with whatever course you choose.

Nellie

Scott, a few thoughts. I hate to throw a curve ball, but you might consider talking to a medical oncologist. Even someone like Dr. Scholz or Dr. Lam. You are young with a fast post-RP failure and pretty quick doubling time. Just speculating mind you, but you could be dealing with a systemic situation. I would not mess around at this point. I would definitely not exclude HT at this point in the decision process. Radiation to the lymph nodes + HT could indeed a be a very solid consideration. Again, listen to your docs and decide. But, although HT is a hassle, it is most defintely doable. A lot of us can help, encourage, and advise in terms of managing while on HT if you choose that route.

Building on BB_Fan's comment: yet another option for consideration is to start HT right away to halt/slow down progression and delay radiation until you are totally dry.