Post surgery data update

Hi All,

Surgery in 2018 and just got my 3rd quarterly uPSA reading.

Data so far:
3 months post surgery: .022
6 months post surgery: .042
9 months post surgery: .063

On other fronts all good with the exception of persistent lower back pain for past 4 months. Docs identified bone lesion suspicious for met on MRI and then did a subsequent MRI where they indicated it is unlikely to be a met. Interestingly, my surgeon suggested radiation after the second read but the radiologist wanted some more data to be followed by scans. I understand that the trade off is zapping early vs waiting and knowing where to zap (or not).

Any feedback concerning timing of intervention would be great. I have tried to pin this down with RO but he is a bit elusive on this question. Will be meeting him next week

Thank you fiddlecanoe,

Continence very good, ED is a work in progress with emphasis on “work”...🙂

Sorry for the increasing PSA. It is probably time to consult with a radiation Oncologist. I think salvage radiation is in you r future.

Greatly appreciate the responses. Thank you.

Conundrum seems to be that the only way you can find out where the cancer is located is to wait for the PSA level to rise to levels that, while detectable through scans, have been shown to be “late” in terms of salvage treatment. Am I misreading this?

It would be great to know where the PSA is coming from.

If cancer is out of the pelvic region, or metastatic, SRT is probably fruital.

Your PSA is most likely too low right now for one of the newer PET scans, such as 68 Gallium, to be very accurate.

Of course, you could take a chance and go ahead with SRT to the prostate bed & lymph nodes and hope that is where the cancer is. That would give you a possible cure.

Bobby Mac

AJMan,

Appreciate the thread. I'm in a similar boat. Surgery Septemer 2018 and have PSA:
4 weeks PS: .07
10 weeks PS: .08
16 weeks PS: .10
That is about a 6 months doubling.
Going for appointment with RO tomorrow. Tough decision on what to do as there's no way of knowing whether it is localized or spread at such low levels. Couple worries are incontinence/urinary control is not yet close to pre-surgery and no signs of life on the ED front. Adding to those concerns is having a stricture in my urethra which carries a risk of tightening through radiation. So radiation could make all that worse and isn't certain to address the PC.
Thanks,
Bill

AJMan--

I understand your latest post to mean that given your pathology (tertiary 5, extensive EPE), your RO suspects the PCa has already left the prostate bed and he's waiting for mets, or for spread to the pelvic lymph nodes, to show up on a PSMA based scan. If mets, radiation's not the answer; if pelvic lymph nodes, perhaps whole pelvic SRT. Am I drawing the right inferences?

ROs tend to jump at the chance to radiate you, so if yours is recommending caution, that may be the right course. But if you're uncomfortable waiting, or uncomfortable with this RO (your remark about him being "elusive" come to mind), why not get another opinion? If there's concern that the cancer has already spread, maybe consult an MO to get a different perspective? Also, have you had any discussion with your uro or RO about ADT?

--SP.

Saipan and Garyi,

Thanks very much for your comments. I see you have both been down this road before me. While I am comfortable with my RO's posture I am not really sure I can explain why and I completely agree with your suggestions on seeking another opinion (have been a bit on the fence and thank you for the push). I think it is a combination of potential for getting a future reading on a scan, some suspicion it may be out of the bed and leaving some additional time for things to potentially improve on the ED front. Per your inference Saipan, he did note the decision between whole Pelvic SRT as being potentially informed through scan. He also mentioned ADT and cited evidence suggesting it would be potentially beneficial in my case but we would make that call later. URO's take is more "do the radiation now and if it doesn't work you know it wasn't in the bed".

Thank you!

Largebill68 said...
AJMan,

Appreciate the thread. I'm in a similar boat. Surgery Septemer 2018 and have PSA:
4 weeks PS: .07
10 weeks PS: .08
16 weeks PS: .10
That is about a 6 months doubling.
Going for appointment with RO tomorrow. Tough decision on what to do as there's no way of knowing whether it is localized or spread at such low levels. Couple worries are incontinence/urinary control is not yet close to pre-surgery and no signs of life on the ED front. Adding to those concerns is having a stricture in my urethra which carries a risk of tightening through radiation. So radiation could make all that worse and isn't certain to address the PC.
Thanks,
Bill

Bill, I wonder if a period of some other therapy before going to radiation is an option ? I have zero knowledge then what I've read, but I've heard docs prefer delaying radiation post-surgery for a bit to give the body more time to recover and lessen SEs.

Thank you PGDuane. I wish you all the best for your treatment path to deal with this once and for all!

Saipan, I hear you and your point makes good sense. Thank you.

LargeBill, I see this was your first post to this site. You may want to also consider starting a new thread with your situation. I have received tremendously valuable inputs and thoughts from this community.