Another PSA Test With My Radiation Onc.

hello, everyone.
thursday, i went to meet with my radio onc. he told me that i was his most knowledgeable patient in the area of PCa he's had in a long time. i attribute that to all of you who've been a huge help to me. so, anyhow, i went to discuss radiation therapy in more detail, esp. after i told him john epstein downgraded my PSA to low grade G6, plus the bone scan showed no evidence of spreading. based off of that information we discussed whether or not i should do either AS or brachtherapy alone. once he found out i hadn't been tested for my PSA since last year, he wanted to order another PSA and told me that if it's like a 20, he'd suggest hormone therapy along with radiation.

well, he call'd me back, with the results, but i missed his call. when i him called back, all he could tell me was my PSA is 18, up from 11.9 from last year. he said he needed to get off the phone and would call me tmrw. i've noticed over the past few weeks my urinary symptoms through out the past few weeks have increased, not severe, but more often. so, i'm pretty concerned about what his suggestions will B.

what type of impact will this have on my overall prognosis?
should i consider surgery instead?
is the cancer getting worse, because of no treatment just yet?
i have no idea what to think. what R your thoughts? i'm scared U guys.
Below is my signature
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D.O.B. 1973
07/14 PSA 5.5
08/14 TRUS Bx Prostatitis & BPH
07/15 PSA 5.9
01/16 PSA 7.6
03/16 PSA 6.2
07/16 PSA 6.9
10/16 PSA 6.9
03/17 PSA 7.2
05/17 3T MRI Good
11/17 PSA 7.7
11/18 PSA 10.8 Cipro for 2 wks
07/18 PSA 11.9
08/18 3T MRI: 3 per ZN focal ABN, 1 with a PI-RADS 4 lesion & 2 with PI-RADS 3 lesions. No extra PCa disease, pelvic LAD, or pelvic lesions
02/19 MRI fusion biopsy
Bx Findings
A. PROSTATE, LESION 1, LEFT APEX, 3D MRI FUSION BIOPSIES: * BENIGN
B. LESION 2, RIGHT MID GLAND *PCa, GS 4+3=7 (GRADE GRP 3) 3 OF 3 CORES
(95% DISCONTINUOUS, <5%, <5%) * GS GRADE 4 60% OF THE TUMOR
0 PERINEURAL INVASION IS PRESENT
INFLAMMATION.
C. LESION 3, DIFFUSE LEFT MID GLAND, 3D MRI FUSION NEEDLE CORE BX's
PCa, GS 3+4=7 (GRADE GRP. 2) LESS THAN 5% OF THE FRAGMENTED CORES
GS GRADE 4 INVOLVES 5% OF THE TUMOR
2nd Bx OPINION
A. Benign
B. PCa, GS 3+3=6 (Grade Grp. 1) 80% of 1 core
C. PCa, GS 3+3=6 (Grade Grp. 1) 20% of 1 core
Considering options

F8 said...
surgery would be my last choice of treatment.

Why would surgery be your last choice of treatment? What would you do?

Post Edited (Sammas) : 5/18/2019 12:15:36 PM (GMT-6)

It's important to note that there could be other factors driving your PSA than prostate cancer--I notice that you have a history of prostatitis. That said, the high number definitely merits further investigation.

Regarding treatment options, I don't think those have changed with the recent news. Low-volume G6 would normally be OK for AS, but your high PSA likely precludes that. (At the same time, that PSA could be high due to an infection.) Surgery is a valid option, but I don't see why the increased PSA makes that a better choice than it was prior to this news--the cure rate with radiation and surgery is about the same.

And I could see why you'd be scared, but prior to treatment the PSA score is probably the least predictive bit of data in determining your outcome. More important is your Gleason score and the results of any of your scans. Nothing has changed there. I think you just need to methodically assess your options--starting with your RO.

Sammas said...

F8 said...
surgery would be my last choice of treatment.

"Why would surgery be your last choice of treatment? What would you do?"

I went with a combination treatment that was designed the eradicate the disease as long as it was confined to the prostate bed. i had a 60% chance of a "cure" and if i post a zero next month i'll begin my 10th year of post-treatment remission. i have never been incontinent, my penis is the same length and my ED is controlled with Cialis. to be fair i think surgery is the worst choice in most cases, and if you truly have a PSA of 18 and are a G7 i would recommend an aggressive, non-surgical treatment.

sorry to be blunt but that's what i believe.