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I'm a 78 Year old healthy (other than PCa) individual and not over weight by any means. PSA in Mar. 2016 of 20. Aug 40 PSA and in Dec. 55. Radical Prostatectomy Dec.2016 at John Hopkins. Follow up with surgeon in March 2017 with a PSA of 0.1 undetectable. But due to the biopsy of the prostate indicating that the cancer had left the prostate as well as a Pet scan, with PSMA in Dec. 2016 prior to surgery showing many areas of PCa. Dr. reccommended that I start radiation treatment right away at follow up. With a PSA of 0.1 I suggested we wait 3 months and if the PSA was still 0.1 then no radiation therapy. June follow up: PSA 0.4. Now we have to do something! My questions to this forum are: Would you start radiation therapy now, or watchful waiting? The PSMA will not show the cancer under PET Scan at such a low PSA number now, so it is not available to be used this go around. Advise?
Good advice from "O.C."! Waiting at this point would negate the sacrifices you made to this point to beat the disease. O.4 may not seem serious but the increase means there is still growing cancer cells so the prudent thing to do is to attack them now while there may still be a chance to stop them. Procrastinating will serve to give the cancer a chance to mature and spread while further treatment at least may give a chance to arrest it if it is still localized. Jon.
I had a radical prostatectomy in July 2013. The post surgery pathology indicated cancer in one lymph node. My PSA in September 2013 was 0.17 and 0.38 in November 2013. I started hormone therapy ( zoladex ) in November. My oncologist would not agree to radiotherapy so I obtained two further opinions. Both of these oncologists recommended radiotherapy, but as I was receiving hormone therapy and my PSA was then undetectable, they felt I should wait at least six month post surgery to allow the healing process to take place. I received 37 cycles of pelvic radiotherapy in July and August 2014. I continued to receive zoladex implants at 3 monthly intervals until January 2016. Thankfully my PSA is still undetectable. I agree that watchful waiting isn't a sensible option when PSA levels continue to increase after surgery. I hope this is helpful and your treatment goes well.
Radiation and 6 month Hormone treatment ASAP. You may get lucky and have no problems with the radiation like me and I think most people. You need to prepare for the hormone treatment by starting an appropriate exercise program and watch your diet/weight gain. I think most patients will say that their fear of treatment was far greater than what it is actually like. The 33 treatments were like going to a spa for me and you meet the nice people running the machine.
Terry, you say "the PSMA will not show the cancer under PET Scan at such a low PSA number now", but actually a PSA of 0.4 is not too early to get a Ga68 PSMA scan. It may not show anything, but is highly like to do so.
With a post surgery PSA rising from 0.1 to 0.4 so quickly, there is something very serious going on. Sitting back is not the way to go. Maybe it is not too early to start ADT treatment (Casodex, Zoladex, etc), and have a GA68 scan and then be prepared for some targeted radiation sooner rather than later.