jkwleo

I have a question here...
I am 68. I did SBRT radiation 7 years ago..PSA had been stable until last year... it went up from .50 to 1.95 in an year.
I am wondering if this is abnormal or what ?
If you can help me here. Thank you!
Leo

My RO wants to do PET scan. What are the treatment options for Post SBRT ?

Thank you Halbert,
I understand that it is alarming because of the upward trend.
But with PSA=1.95, can it be other factors causing the index to go up ?
overall it is still below the cut line of 4.0.

Hello Jonll - don’t panic, this did not happen overnight and is technically not a failure yet (+2 over your lowest value, nadir). PSA < 4.0 is for untreated men and does not apply anymore. Your RO is suggesting the correct next step. Another confirming PSA would be prudent also.

As halbert noted, it really depends on what the PSMA scan shows, if anything. Sometimes there is a flareup in the old prostate so a focal treatment can address that. There is a recent post here of someone going through that situation.

The scan can also show something going on in the local area such as nearby lymph nodes. After that, it could be anywhere including bones, nearby or distant. This part gets a little tricky as just a couple of lesions can be zapped whereas widespread findings leads you to the chemistry lab, the domain of the medical oncologist where there is no shortage of treatments nowadays.

No reason to get too excited yet, that can come later when you have some facts to base your feelings on. Right now you have a suspicious number to be investigated. Let the doctor tell you when you have a problem then address it. Easier said than done, I know, but don’t let your mind wander to worst case scenarios. Hang in there…

If the PSMA scan shows one or two trouble spots, they can be treated with focal therapies. There are quite a few of these nowadays, but because they are relatively new, real long-term data are sparse. I suggest to take one step at a time and first see what the PSMA scan shows.
You should also get follow-up PSA tests. Perhaps you are seeing a late bounce. Prostatitis could be another reason for the jump.

jonil said...
Thanks a lot Stephen, Mumbo...
I am not familiar with these post SBRT treatments... general speaking, are they effective ?

A PSMA Pet is not a treatment. it is a new kind of imaging tool that was approved since your treatment 7 years ago. It shows any spread of your cancer sooner, but may not show all of the spread.

The results of your scans will then lead to one or more actual treatments. I am not that familiar with secondary treatments after radiation as I had surgery. There are plenty of guys here though that had radiation and secondary treatments who can answer questions about treatments after radiation.

jonll said...
Exactly Stephen S,
Would like to hear from folks who have gone thru the secondary treatments after radiation.
Hope they can shed some lights here...

Hello fellow traveler. I had my prostate removed via robotic surgery and then had radiation. 12 years later psa went up to .75 to 1.4. PSMA scan showed prostate cancer in 3 areas involving my pelvic lymph nodes. The treatment: Radiation 28 sessions (In my case, Proton beam because I had radiation close to the new areas of interest.) and Androgen Deprivation involving 1st and Second Generation agents. This means a shot once a month and 5 pills a day for 24 months. (Firmegon shot once a month and Abiraterone (with one pill of prednisone), Once they know where the cancer is, radiation (maybe SBRT for a short time, or maybe 28 session type) is done to the suspect area. The androgen deprivation lowers your testosterone to starve and kill the micro cancers that may remain in your system. Hope this makes sense. There are treatments now that would never have been done just 5 years ago, including mine. There are treatments but make sure you get a good Medical Oncologist and Radiation Oncologist to guide you through this maze. Good luck to you. You have come to a special place for advice with many great people who have helped me so many times.

Leo, Sorry to have you back here. You’ve been given some excellent information and I’m sure if you share your location one or more members might offer additional information regarding their experiences with specific providers or care centers. Looking at your signature I see the PSA results from one year post treatment as well as the last year or so. It looked like you experienced a bounce about 12 months post SBRT. From year two to five did your PSA fluctuate? I two was treated with SBRT about the same time as yourself and my PSA bounced around for a couple years before slowly assuming a slow decline. At this point I believe you’re doing the right thing in trying understand what’s going on and to gain information regarding what to do next. This is a good place to do that. Best wishes…Terry

My PET RESULTS just came:
Abdominopelvic lymphatics:
An avid 0.4 x 0.4 cm left internal iliac node shows SUV 4.2, suspicious for metastasis.
IMPRESSION:
Gozetotide PET/CT shows an avid 0.4 cm left internal iliac node, suspicious for metastasis.

do I need to be treated ? your advices are highly appreciated.

Hello PaxNova,
I am pleased to know that you are doing quite well after the treatment.
I really appreciate for your advice !

I was a Gleason score 9, had a prostate removed , couple months later PSA rises, had radiation and was good for a couple of years, started rising again , put me on three month lupron shots and daily xtandi, have been <0.1 for over two years now.

jonll said...
RO suggests radiation and hormones..
he said that: hormones shot and hormones pill are equally effective in anti-cancer effect. The main differences are in how they are taken and how fast it wears off (pill wears off slightly quicker).
Can someone translate what he was saying?
Thank you!

A single Lupron injection tends to be good for 3-6 months whereas Relugolix pills are taken daily as a typical examples. There are some advantages to pills for overall health.
If you are on Medicare, office injections are covered under Part B whereas pills fall under Part D which has been a cost problem. Medicare now has an out of pocket maximum for drugs so not quite the past problem. Private insurance is another issue and can be more complicated.

Jonll, sorry for your situation. It's not that the pill works better. Both the pill and the injection, do the same thing, they crash your testosterone, its referred to as chemical castration. Unlike surgical castration, it's reversible.
The pill, once stopped, allows you to recover, and your testosterone to rise back to where it was before treatment, more quickly than the injection. I had the injection and it took a year for my testosterone to go back to normal and for side effects to subside. When I was treated, in 2019, the pill did not exist.

Speaking of side effects, most people do experience hot flashes , usually manageable, but not necessarily fun. And libido drops , you may not be interested in sex, or even in looking at beautiful women. And there can be cardiac side effects, important to consider if you have heart issues... it can play havoc with your lipids. My understanding is that the pill has less of a negative effect on lipids, I could be wrong about that, but you should do your own research... google "orgyvyx" thats the name of the pill.

The treatment whether pill form or injection, will not cure you, it will put the cancer to sleep so to speak, and so your PSA will drop pretty quickly. What it will do though, is make the cancer cells more susceptible to radiation, and the hope is that for that reason, the radiation will work better, and THAT will cure you, at least that is the hope.

You should educate yourself by doing some reading on this stuff. Lots can be found on Google, just be careful that what you are reading is scientific, not hearsay, anecdotes , or alternative medicine proponents.