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Re: Rising PSA 1 year after robot assisted radical prostatectomy

Hi S,
Biochemical recurrence of prostate cancer following radical prostatectomy is defined as a rise in PSA to 0.2 ng/mL. Your PSA is still in the normal post operation range S. So as Mark suggests get on with your life and have a good chat with your urologist next visit.

John Bonneville

Re: Rising PSA 1 year after robot assisted radical prostatectomy

I was just about to ask the same question, but let me color it somewhat and see if there is more discussion. I"m 18 months post RP - just as Covid hit. My ultra-sensitive PSA started at .011 and has been .032 for 6 months. My path however showed extra-cap extension and one lymph was positive. Path was 4+3 and the Decipher test was slightly aggressive (Decipher carries a intermediate level of evidence). I'm 69 and have a "pristine" cardio system with no comorbidities. Meaning, prostate has a good chance of being the thing that eventually gets me if I wait around long enough. So what to do? Some would say rejoice - PSA is <<.1. Enjoy the period before you have to do something. The great debate is does radiation and hormone suppression at this point change the prognosis? There is no clear answer - it depends. If the PCa is still very local to the lymph nodes then radiation might end the story now. ADT is taken to increase the effectiveness of the radiation. One radiation oncologist said, you are healthy, if your purpose is to live as long as you likely could .. throw the kitchen sink at it. So I too am at a cross road. The last piece of data is a PSMA PET scan now scheduled for UCLA that will likely be negative but might give some evidence to where radiation should be aimed. (PSMA PET scans at UCLA) show 30% traditional radiation aiming misses where the cancer actually is at the edge of the exposed area. 30% of those patients have a relapse within 3-5 years.

So I would reflect on the question you asked, test what other information you need to have in hand to make a decision. Thoughts of others?

Phil

Rising PSA 1 year after robot assisted radical prostatectomy

Thank you. Mine is >.1 (it's .11).

Re: Rising PSA 1 year after robot assisted radical prostatectomy

Well P in all likelihood your PCa is going to progress, especially given the lymph node involvement. Yes focal EBRT may be effective provided the spread is localised. If longevity is your aim, given the absence of comorbidity, then robust intervention is warranted now. Of course, you could just observe the rate of progression over time, and treat conservatively, but the curative window would be closed. Fortunately, aside from the end stage of the PCa journey, a comfortable
lifestyle can be had. Your dilemma though is trying to predict outcome on today's evidence which may be at odds with tomorrow. So bottom line, it is your call. Suffice to say from my perspective, going through the end stages of PCa, as many on here have done, would not be my first choice for an exit strategy.

John Bonneville

Re: Rising PSA 1 year after robot assisted radical prostatectomy

Many out here fully understand your concern. This is a tough place to be especially after such a short time in it. As you probably already realize, there is no one correct answer. Listen to others and make your own decisions. BUT - DO NOT PANIC! I am seven(?) years out from my treatment and though I am not assured of the cure, it is no longer such a forefront fear. Maybe that is good and maybe that is bad. Get your PSA checked at regular intervals and keep track to see any definite and/or fast trend. Your .11 is not a sign of failure but needs to be watched for a trend. My PSA has risen to .16 from a .11 in six years. This lab always seems to be about .05 higher than the other lab I go to so each lab is different also. The VA lab only goes as far as .1 and so far it has stayed below that threshold there.

So, yes it is a gamble of sorts. My outcome after RP was uncertain from pathology with a fairly rapid first year advance from .09 to .13 so I opted for the "kitchen sink" option of radiation. Did it work? Hopefully, but no guarantee in this game. Radiation is easy but not to be taken lightly. It can cause its own problems years down the road I am told. Don't know if this is helpful to you or if it just throws another angle at you to decipher. Hang in there, if I can be any help, contact me, Jon.

Rising PSA 1 year after robot assisted radical prostatectomy

Pre-surgery Gleason 4+3
June 25, 2020 Radical Prostatectomy (Robotic)
Surgical pathology Gleason 3+4
All good. PSA 0.0 for 13 months.
Then...
1/28/21
.00
7/29/21
.11
9/8/21
.14
10/5/21
.23
10/11/21
.22
10/25/21 PSA test scheduled
11/5/21 PSA test scheduled
NM 10/9/21 - All good.
Waiting to see if I can get PSMA.
Surgeon surprised considering all seemed to be low risk.
No tests done yet (we're starting) but, after my request, referred me to radiologist.
Radiologist states 2 consecutive +.2 PSA readings should trigger hormones (6 month) + radiation. Not a matter of if but when. And no matter what tests show, prostate bed radiation is a given. Added if I wanted to start now because of my anxiety he would. (Not sure if he was serious.)
Do you have any thoughts?
Being treated at Cancer Center of Excellence

Re: Rising PSA 1 year after robot assisted radical prostatectomy

Yes, it appears there is reason for concern after your rising numbers in the last few months. Time to get serious about the next move. I have no knowledge of what a PSMA can do but anything that might give more clues as to what and where the problem is before doing the radiation might help "steer" that treatment to the trouble spot more accurately. I know a lot of docs. prefer to do hormones before radiation to try shrinking the problem. I have no knowledge there either as I did not have that. Just went straight to radiation of the prostate bed. Don't fear the radiation. It just takes up some of your time each day. I still have seen no side effects from it but was told by the radiation doc., when/if they show up in my 90's, to see him and we will have a drink over it. Radiation is the last chance for a cure so go for it. Jon.

Re: Rising PSA 1 year after robot assisted radical prostatectomy

Thank you for the good, solid, and encouraging advice.

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