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Failed salvage radiation or not?

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Posted 9/10/2017 2:42 PM (GMT -5)
Thanks, Bohemond and Tall Allen for your very pertinent comments. I never thought of my doubling time as being high - given the low level of psa. Low numbers will mathematically give a high doubling time but if the rate of psa increase stays flat at 0.1 per 3 months, I am thinking the doubling time is not great. However, I recognize the doubling time will increase over time. So I will think differently about it going forward.

I have pondered the idea of scans - and still might do that however I recognize the risks as you both point out. Finding one met and killing it off will likely bring another, and I hate to wait until psa gets above 2 to get a scan and allow more mets to possibly occur.

I will discuss the zytiga option with my MO at Sloan Kettering in early October and will update all.

Regarding Axumin scan - will the MO be able to advise on this? If not, how do proceed to investigate?

thanks so very much,

Teddy
Posted 9/10/2017 3:01 PM (GMT -5)
I agree with you that PSADT has not been validated for very low levels of PSA (below 0.1), but it is validated for PSA over 0.1. I think they like to see at least 3 data points:

/www.mskcc.org/nomograms/prostate/psa-doubling-time

As for the PET scan, MSK has an ongoing clinical trial of the Ga-68-PSMA-11 PET/MRI that you seem to qualify for:

/clinicaltrials.gov/ct2/show/NCT03204123

Call Dr. Wolfgang Weber 212-639-7373 to arrange and find out what the costs are. If the cost for the PSMA PET is too high, and your insurance covers the Axumin scan, he would probably know how to arrange for that at MSK as well.
Posted 9/10/2017 3:19 PM (GMT -5)
Thanks Tall Allen for your guidance on this. I will follow-up.

Teddy
Posted 9/10/2017 4:07 PM (GMT -5)
Teddy 9
Axumin scan should be approved. All you need is recurrence by PSA rising and referral from your RO but I was advised to let PSA rise to 2.0 to ensure a productive scan. I don't see where you had any ADT along with your RT. But I guess you were on the bubble?
Bob
Posted 9/10/2017 4:19 PM (GMT -5)
Break, yes I had 6 months of ADT concurrent with radiation.
Posted 9/10/2017 5:46 PM (GMT -5)
Sorry. Forgive me for failing to read your signature completely!
Ok so like me your PSA started to rise after stopping ADT. I also had 6 months with SRT. But I had worse pathology than you after RP but no node involvement. A full body scan will find where recurrence is located and hopefully it's in a place which can get treated with SBRT or if not, imrt. SBRT is so much more convenient! You'll notice in my signature that I've had two RT and ADT treatments after SRT ( I'm still on ADT) . No mets have been found anywhere that had been treated with RT.
Bob
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