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psa rising slowly

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Posted 9/7/2018 11:35 AM (GMT -5)
I have not logged on to this board for quite a while. Sorry to see the discord from such a good long time source of prostate cancer help.

I would like some opinions on my rising PSA. As you can see I had surgery in 2007 and radiation in 2015. My PSA has never been undetectable. It has been around .2 for years and years. ADT has been discussed but I have never pursued that option. Over the past 12 months my PSA has doubled from about (.2) to about(.4). I have a doctors appointment in two weeks.

The obvious next step would be an MRI which might not show anything at my low psa levels. The doctor might also suggest ADT, which I would like to avoid. Please share your opinions and possible treatment or non-treatment possibilities.
Posted 9/7/2018 11:46 AM (GMT -5)
Lifeguyd, if i understand correctly, you had very low, persistent but stable PSA for a number of years, and now it is rising with a PSA doubling time of about 12 months?

From what i know, and i am not an expert, it would seem you should seek out a clinical trial to get a PSMA PET Scan. At .4, you would qualify, and there is a decent chance that if you have mets (although there is always a significant chance of a false negative), it might show something. That would help determine if ADT and SRT would make sense. Not sure where you are located but if you google "PSMA PET SCAN CLINICAL TRIALS PROSTATE" it will come up with a number of locations. I know it is available at the NIH in Washington (or Virginia not sure)

If you have the PET SCAN and it is negative, i THINK there is a good probability it would be in the prostate bed. This is based, on what the doctors told me: that a long time to BCR (.2) and a slow rate of rise (which you have) is a good indication of a high probability that it is there. In that case, seems like ADT plus Salvage Radiation would be a solution.

I AM NOT A DOCTOR, speak to your medical professional about this. Others more knowledgeable than me will weigh in.
Good luck
Posted 9/7/2018 11:56 AM (GMT -5)
Thanks Pratoman. Actually I had the salvage radiation three years ago. Information regarding the viability of a PSMA scan and trials is helpful. I am located in northern California so could have access to experts here, however I am limited by my HMO and my own financial insecurity.
Posted 9/7/2018 11:58 AM (GMT -5)

lifeguyd said...
Thanks Pratoman. Actually I had the salvage radiation three years ago. Information regarding the viability of a PSMA scan and trials is helpful. I am located in northern California so could have access to experts here, however I am limited by my HMO and my own financial insecurity.

Sorry Lifeguyd, i missed that in your sig, i see it now.
I believe UCSF is offering the PSMA PET clincical trial. Tall Allen or others may be able to chime in with a contact. Not sure if the fact that you already had SRT would disqualify you, but its worth asking

.
Posted 9/7/2018 5:59 PM (GMT -5)
UCSF / University of California San Francisco has invited me to participate in their ongoing trial of the Gallium-68 PET. However because I am in an HMO, my out of pocket costs might be too much for me to afford. I hope my HMO can provide something that will provide good information at a price I can pay.

I assume that I will proceed with ADT in the meantime. Your thoughts?
Posted 9/8/2018 7:31 AM (GMT -5)
Yes, I think ADT would be your next course of treatment..But since your doubling time is very slow, maybe you could could postpone it for a while..I would talk over the positives and the negatives with your doctors..
Posted 9/8/2018 9:42 AM (GMT -5)
Sorry to hear your PSA is rising. ADT is the next step. The normal scans available at this point aren't likely to show anything.

The conversation to have is when to start ADT and if intermittent ADT is an option. At .4 you could likely wait a little while before starting ADT.

Andrew
Posted 9/8/2018 10:08 AM (GMT -5)
If your SRT didn't include the lymph nodes there may be that is where the cancer is and a chance for cure.

If it were me, my next step would be the 68 Ga PSMA scan to find where the cancer is.

Bobby Mac
Posted 9/8/2018 11:32 AM (GMT -5)
Thanks for all the good suggestions. I meet with my doctor next week. I hope the Gallium-68 PSMA-11 PET will be an option for me. I have been followed around by this prostate cancer thing for more than 12 years now. I really doubt it will ever go away. UCSF told me I would be accepted even though I have had both surgery and radiation. Am I just wasting my time confirming psa activity when the treatment will likely be the same?

Any and all comments are welcome cool
Posted 9/8/2018 12:49 PM (GMT -5)
When you had SRT, where the lymph nodes radiated? The question is are there distant mets? If yes, then ADT is your next choice. The scan might show you lymph node involvement which might, maybe let them do a bit of spot RT. But I'd think that a long shot.

You need to keep following your PSA to know when to start ADT.

Do let us know what your doctor says.
Andrew
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