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SRT - PSA back to undetectable

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Posted 12/2/2021 2:19 PM (GMT -5)
Hi,

I have posted before on this. My boyfriend had RP in Dec 2012.... Pre-RP PSA 4.2...clean margins, 3+4, no adverse pathologies. In May 2019 lost < sign.... slow creep to .13 in June of 2021. 7 weeks of radiation to prostate bed July/Aug without ADT. Finished mid Aug with minimal adverse reactions... just fatigue. Sept PSA dropped to .04. Just tested again and happy to report the < is back. Back to undetectable! Hopefully the speed to undetectable is a good sign and we'll stay there. I know there is always a lot of discussion about whether or not to do a short term of ADT with SRT. From what we have read, a low PSA (below .2) going into SRT is optimal, and with no other adverse pathologies, it is safe to do SRT w/o ADT. We opted for that route and are pleased so far. Just sharing for anyone considering SRT. Dr. Samadi was his surgeon and Dr. James Wong in Morristown NJ was his RO.
Posted 12/2/2021 3:07 PM (GMT -5)
teddy - I did ART with no ADT as my PSA <0.10 but I had a higher risk pathology. When I questioned my RO, he said this was the appropriate thing to do based on studies available thru 2019 where the benefit of ADT was negligible for my case (within 6 mos of surgery and PSA <0.10). He said he could add ADT if I really insisted which I declined given his compelling argument

Your boyfriend is probably in a similar position although a lot of time has passed and he has the low but measurable creeping PSA. Probably can go either way depending on his RO's view of such things. In any case, I would not look backward and proceed full steam ahead with life.
Posted 12/2/2021 3:25 PM (GMT -5)
Great report Teddydog.
Michael
Posted 12/3/2021 8:36 AM (GMT -5)
Great news! I live in Morristown and had my RP done here. I’ve heard good things about Dr. Wong. I wish you the best moving forward!
Posted 12/3/2021 9:37 PM (GMT -5)

Loved reading the phrase "BACK TO U-N-D-E-T-E-C-T-A-B-L-E" in your new post!

If we were playing SCRABBLE, the word "UNDETECTABLE" would be worth TRIPLE WORD SCORE, for sure!

It's a GREAT DAY to read your GREAT NEWS, TEDDYDOG!

Weekend is here --- celebrate this good news!

CYCLONE - # Iowa State University
Posted 12/6/2021 6:17 PM (GMT -5)
Hi Teddydog,

That's great news for your boyfriend! I wish him continued good health and lots of zeros.

My husband seems to have a story that's very similar to your boyfriend's stats but we're still trying to decide what he should do. We have talked with three different ROs, and have received relatively different advice from each it seems. (I plan to post this info in a new thread because it could be helpful for others going through this.)

Do you have access to your boyfriend's pathology report? If so, I'd love to ask some questions about the lymph node testing that was done.
Posted 12/7/2021 9:21 AM (GMT -5)
Hi Melaine,
So I have some info... I do not have all the gory details of the pathology, but I can tell you that it was 3+4, occupied 25% of the gland and the lymph nodes and margins were clear at surgery. Not sure how many nodes were tested. Surgery was in Dec of 2012. He stayed undetectable until March of 2019. History of PSA below.

Date PSA
March 28, 2019 0.03
Sep 30, 2019 0.03
May 28, 2020 0.05
Nov 12, 2020 0.07
May 11, 2021 0.13

Covid sort of screwed around with our PSA test dates. After the .07 we said we would watch to see if it stayed stable because it really had been a slow creep. When we got the .13... which was much bigger than the slow creep, we decided to pull the trigger. Everything you read indicates that SRT below .2 is optimal. We were concerned that if we waited any longer, we could have jumped over that .2 mark. Thankfully we're back to undetectable. His prostate bed only was radiated. Hindsight being 20/20, knowing what I do now... I think we may have pulled the trigger at .07 instead of waiting for one more PSA. Covid was a factor as we really weren't as focused on PSA at the time. His surgeon would have been OK with waiting for another PSA... I really pushed the issue after the .13. Did not want to get over the .2 and miss an opportunity. Hope this helps.
Posted 12/7/2021 5:25 PM (GMT -5)
Thanks for that info, Teddydog.

The reason I ask about the lymph nodes is that is appears that my husband's surgeon (same as your boyfriend's) didn't really do the lymph node dissection that we had anticipated. As a result, we're in the dark as to the status of my husband's LN. If you do find the pathology report, please let me know. Just curious as to whether your boyfriend's surgeon took only 1 LN from each side and, more important, whether what was taken out turned out to be lymph tissue. (In my husband's case, the LN on one side--the side with the most cancer--was really only fatty adipose tissue.)

Thanks, and continued good health to your boyfriend.
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