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PSA rising to 0.11, 5 months after RP Surgery

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User
Posted 16 Sep 2018 at 13:00
If you are a T3 you are entitled to ART if your consultant thinks there is a benefit, that's always been the case I believe.

The trend all over the world has been to use much less ART largely (I beleive) as a result of USPSA.

The biggest single danger with PCA is overtreatment this too has probably driven the move away from ART over the last 10 years.

Like most things it may now be overdue a correction.

PS Fresh I think you are wrong about Gleason score (but maybe for the right reason?).

GS is a physical manifestation of what has happened and is a proven indicator of disease pathology. No it doesn't explain everything but the stats certainly support the fact that a G5 is worse news than a G3??
User
Posted 15 Oct 2018 at 10:52

Hi All


 


Just an update to this thread. Second PSA now one month apart as of 11 October is 0.16.  On 12 Sept it was 0.11, which shows it advancing fairly rapidly post operation in April.


 


So end May <0.03


September 12 - 0.11


October 11 - 0.16


We are living in Germany currently so it is always a challenge to speak to Doctors or challenge the tests and our insurances doesn't seem to cover the PSMA/PET scans so have to pay for that.  Anyway we have a tentative PSMA/PET scan in Heidelberg on Oct 29. I believe they will use some test which is 18F as prefix, so that means it should be more sensitive to finding where this new growth is. The Prostate Bed, the lymph nodes or further out. They took out 32 lymph nodes from the pelvic region in the RP which all of them showing negative. But it takes only one to be positive I guess to cause this, it is like hyper worrying why it is going up so fast.  Thanks again all for your comments.  I had to take a breather to relax before but now I am back on this journey again.  take care all

User
Posted 15 Oct 2018 at 10:56

Anyone know of a similar situation of PSA rising so rapidly after RP? My Gleason was 7B so fairly aggressive, but obviously there must be a fair chunk of cells sitting somewhere expanding !

User
Posted 15 Oct 2018 at 11:11

Mine was 0.05 repeatedly then 0.16 / 0.17 / 0.24 from about 9 months post RP.


I was given a CAT (?) scan and put onto SRT and HT.


I have given up on trying to interpret how bad this is because I have had so many different stories:


*My oconologist refused to discuss any prognosis but initiated HT and RT which I assume they would not have done if mets were a given
*Lynn and others have said in the past to me that 0.17 was typical of stray cells at my staging and recurrence point
*The oncologist who did the talk I attended recently said I was only getting six months of HT with the RT because that is typical for non high risk
*Someone said above in this thread that 0.11 after 5 months is rapid and could be stray cells or mets (so similar to mine)


I've given up trying to guess my future apart from accepting that at some point probably sooner rather than later this sodding thing will kill me but I intend to fight it in the interim


I hope your salvage treatment whatever it is sorts this out


P

User
Posted 15 Oct 2018 at 11:22

Hi thanks for the reply and yes it looks as if we are in a similar situation.  Did they ever do scan to prove that it was local or mets? Did your PSA reduce now after all that. What an ordeal, I am dreading the RT, but have to knuckle down and do these things.  The good news is you have caught at early stage both before operation and after, so now it is like living with an acute disease.  Realise that diagnosis is so different it is like dodging the landmines.  All the best and thank you for responding!

User
Posted 15 Oct 2018 at 12:01

Originally Posted by: Online Community Member


*My oconologist refused to discuss any prognosis but initiated HT and RT which I assume they would not have done if mets were a given


*Lynn and others have said in the past to me that 0.17 was typical of stray cells at my staging and recurrence point
*The oncologist who did the talk I attended recently said I was only getting six months of HT with the RT because that is typical for non high risk
*Someone said above in this thread that 0.11 after 5 months is rapid and could be stray cells or mets (so similar to mine)



I was commenting on the pattern rather than the actual numbers. Generally, if the first post-op PSA is undetectable / less than 0.1 and then it rises fairly steadily, this is a classic sign of cancer left behind in the prostate bed and RT has a good chance of sorting it out. If the first post-op PSA is high (like ChrisJ with his 0.15) this is indicative of mets or oligomets and RT is unlikely to be successful. The benefit of RT is less clear when the post-op PSA is low but then rises rapidly.  

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Oct 2018 at 12:13
Midcentury, the 18F tracer could be:

- FACBC 18F - has had good results in biochemical recurrence (BCR) cases - mostly trialled in Italy but now being trialled in some centres in England as well. It is also referred to as Axumin / Fluciclovine 18F - being trialled in the UK and USA.

- Flourine 18F - is the most common tracer but is not so good at identifying small clusters in BCR cases.

However, Flourine 18F with PSMA is quite new and much more precise than Flourine on its own.

There is also a tracer called Gallium 68/F-18 commonly used with PSMA.

Complicated enough without the added issue of translation :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Oct 2018 at 12:17
Thanks for the clarification LynEre. I guess it depends on where the recurrence is, because SRT can really only help recurrence if you know where it is, so doing pelvic irradiation may not get it all. If it went to the lymph nodes it might not get it as an example. Well thats what I have been told
User
Posted 15 Oct 2018 at 12:31
It was actually 1.5 Lyn , a total failure with spread to lymphs. It was 2.2 three weeks later

If life gives you lemons , then make lemonade
User
Posted 15 Oct 2018 at 12:57
I wonder why there is not chemotherapy or a Tamoxifen-like drug for biochemical recurrence for PCa. I am not at that stage fortunately, so have not looked into it.

Cheers, John.
User
Posted 15 Oct 2018 at 14:03

Originally Posted by: Online Community Member
It was actually 1.5 Lyn , a total failure with spread to lymphs. It was 2.2 three weeks later


 


Yes, sorry CJ - fat fingers, small phone :-/ 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Oct 2018 at 14:05

Originally Posted by: Online Community Member
I wonder why there is not chemotherapy or a Tamoxifen-like drug for biochemical recurrence for PCa. I am not at that stage fortunately, so have not looked into it.

Cheers, John.


 


Because chemo can't cure prostate cancer, it can only wound it to make RT / HT more effective. We do have two or three members that have had early chemo with RT/HT combo but it is extremely rare.  

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Oct 2018 at 15:15

@Midcentury - the only scan I had was a planning CAT scan for prostate bed irradation. There was nothing discussed about mets diagnostics. Like I said, the onco flatly refused to discuss anything regarding risk or prognosis. It sounds like they are shoving me on a production line approach to this: SRT - HT - Abi - Chemo - Crem.


@Lynn - I was referring to something way back in my main thread but hey ho, same thing applies, SRT is probably a waste of time for me.


P

User
Posted 15 Oct 2018 at 15:24
I feel positive for you PP - John had similar stats and 5 years on his PSA is stable so the SRT/HT seems to have been successful. Even if that is only a holding position, it has been enough for him to put it to the back of his mind and act like it never happened :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Oct 2018 at 16:32
@Lynn - thanks. A supportive word goes a long way. I’m wobbling badly at the moment because my friend does not have much time left and I’m projecting that situation on to me a bit.

@midcentury - sorry for the diversionary wobble. I should not have played out my own concerns in your thread. What is does lead me to say is if you are having HT keep an eye on your emotional state as that is often (me included) the cause of our ups and downs. I’m in the last week of RT and it has been a long haul.
User
Posted 09 Nov 2018 at 13:06
Here is the latest update. The 18F-PSMA-PET-CT was carried out on Oct 29th. I went for the scan, and they told me that they believed there was something there, and so I went back 20 mins later for another repeat scan again so they could be more certain. Anyway their diagnosis was that they saw moderate uptake in the Prostate bed or Fossa left side, which means a local recurrence, nothing anywhere else, at least at that scan. I have been trolling to different radio oncologists to get their opinions and finally settled on one. The planning scan is next Wed and then after that RT will start in the next week or so. Actually RO couldn't quite believe they found this at such low PSA, but I think my PCa seems to generate a low PSA, while growing quickly. Now will have 37 sessions with perhaps some higher intensity in the area shown in the PSMA scan

I am not looking forward to the SRT one bit, but what can you do, changing diet to more Vegan and Fish, actually changed that over the last months but it doesn't change the PSA rate, but it cant be bad for you. No Hormone Therapy, should I be asking for this?

@ProstatePete glad your SRT went well, Im sure your fatigue will go as you come to the end of your medication as well.

Since I am in Germany for the moment I will have the SRT in Heidelberg and trek there on the train for an hour or something every day, perhaps i have to bring pads and nappies in case. I
User
Posted 09 Nov 2018 at 15:05
Very interesting. Even at much higher psa than yours , both a choline and a psma PET scan have found actually zero on me. My psa is expected to be over 100 in Jan. I’ve still refused SRT given that they have no evidence. Best wishes to you with your treatment

If life gives you lemons , then make lemonade
User
Posted 09 Nov 2018 at 15:18
Mid

I hope the fatigue does go away soon as it sucks :)

My understanding is that HT is a sensible adjunct to RT as it increases the effectiveness.

P
User
Posted 09 Nov 2018 at 15:56

Hormone therapy and radiotherapy combined has better outcomes rather than radiotherapy alone is my understanding.


I started HT three months before salvage radiotherapy and for around two years after.


There are others on this forum who have had salvage radiotherapy without hormone therapy.


Hopefully more comments will come.


Ian

Ido4

User
Posted 09 Nov 2018 at 16:54
midcentury, for goodness sake, eat what you enjoy, avoidng excess. Vegan and fish alone in diet certainly CAN be bad for you. You will miss out on essential minerals and down the track may need vitamin supplementation. As you have noticed your current diet has no effect on the PSA level,so why persist? Give yourself some occasional red meat pleasure!
AC
 
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