Rising PSA after Salvage Radiation

Hello Munster

I haven't been down the same road as you but my understanding is (as just an interested party) that even after removal and RT there can still be a PSA reading from the Prostate Bed,

As the climb in PSA is "minimal" I hope you have a lower reading in December. I can just think the wait for this test will cause I bit of anxiety but I wish you well.

Best wishes

Brian.

Thanks Millibob 

My PSA reading in December was 0.14., third consecutive increase in a row. With Christmas season upon us and a planned holiday in January, we decided along with my Oncologist to wait until February to do another PSA test and potentially followed by a PET scan.

My Oncologist mentioned that I most likely have some cancer on my sternum and said that he may have to restage me. Not sure what to at this stage or what treatment would look like. After a radical prostatectomy, salvage radiation and Hormonal therapy all well within two years, I have made no progress - a little frustrating, but I guess I need a little more treatment.

Kind Regards

Munster

Hi Munster,

what is driving your onco is the histology, namely:

• Gleason score 4+4=8 with Ductal component of approximately 30%
• Lymphovascular Invasion,
• Intraductal Carcinoma (IDC) , 
• Extraprostatic extension

these are aggressive features and require an aggressive approach (intra ductal merely means that the gap, or ducts, between cells are widening, making it easier for micromets to peel away and get up to mischief in other parts of your body.)

however, don’t panic. You have caught this relatively early, your PSA is now still very low,  and the improvement in systemic treatment has come on leaps and bounds.  I was surprised to see that you were recommended for surgery to start with, given that the urologist and surgeon knew that you had aggressive features and that there was a good chance that they might not get it all.  But you are young and they have taken a graduated approach in the hope that they could cure you without the need for systemic treatments (HT, RT etc).

Now that you have had radiotherapy, I think the next step will be the PET scan to see if they can see a breakaway carcinoma (outside the prostate area) - ideally one they can target with radiotherapy.  They won’t irradiate the prostate area again, as you’ve had the maximum dose.  They may also be considering chemotherapy and some adjunctive hormone denying or blocking therapies. 

I am not a consultant, but I hope my comments may steer you to ask pertinent questions when you meet your oncologist.  In the meantime, enjoy your holiday! 

Oh, one other thing. If you’re up to it, I would get them to put you back on hormone therapy before you go on holiday. I know you have had problems sleeping etc, but I really think you need to get your testosterone down and the cancer back in the deep freeze whilst you await the next part of your treatment (if your onco thinks it’s reached your sternum, hopefully they can zap that patch and the PSA will reduce again). AW

Thank you Alpine Wanderer for the feedback and advice.

At 0.14 my oncologist was also concerned that they may not be able to spot the cancerous cells. Risking having to have another PET scan thereafter. With a slightly higher PSA it would make it easier to find. Hopefully another 60 days of waiting will not be the end of the world.

Cheers

Munster

That’s a very good point - they are not putting you on HT so that they can see any other growths. The good news is that they are obviously still pursuing a curative pathway, otherwise they would go straight for the treatment pathway (including HT from the outset). It’s also good that your consultant explained this. Keep us all informed of your progress and we can help you understand further and hopefully prompt questions when you have appointments 

Hello Munster  Thanks for returning to the Community and keeping us up to speed with your progress (or lack of it!). I had a day off yesterday and I come back to find you have an amazing reply (far better than mine) from Alpine Wanderer . Thanks AW.

Best wishes and keep up the fight - enjoy the holiday. Brian.

Two months later and my PSA has climbed a 4th time in a row. It climbed from 0.14 to 0.19 in 60 days. This is now the highest it has been in 2 years after surgery, salvage radiation and HT.

I am scheduled for a blood test and PET scan in 5 weeks. It will be my 3rd PET scan in 24 months. The Oncologist raised concerns about this but said we need to find out where the rouge cancer cell/s are. 

Not sure what to expect at this stage. I am surprisingly calm and relaxed about it all. I will focus on keeping mentally and physically strong and let my Oncologist worry about the cancer.

Has anyone walked down this path with a similar pathology report, treatment history and found themselves in my position within 24 months of surgery?

Kind Regards 

Munster

As my journey continues I continue to read documents to ensure I understand what to expect. I find the Macmillan forum really helpful and continue to learn from fellow men. I seek advise where ever I can to understand and then to try and beat this little problem we all share.

These are interesting documents to read which I found on the Australian Prostate Cancer Forum 

https://www.prostate.org.au/wp-content/uploads/2024/01/04-Understanding-Hormone-Therapy.pdf

https://www.prostate.org.au/wp-content/uploads/2024/01/Understanding-Advanced-Prostate-Cancer.pdf 

Hopefully tis adds value

Kind Regards

Munster

Hi Munster,

Thank you for the brilliant links.

Best wishes

Dafna