PSA up 3 months after salvage IMRT what to do...

Hi Almondnut, sorry to hear about your situation

No it doesn't mean that there is no chance of a cure.

Having said that it's  impossible to say what is going on right now. You may be aware that with RT it can take some time for the effects to filter through.

A lot  obviously hinges on the next psa which should show a reduction.

I'm afraid it means more waiting but hopefully things will work out ok for u.

Best wishes

Steve

Anyone else experienced this? He has not been put on hormone treatment they seem reluctant. 

Almondnut

I don't think HT would be a good idea at this stage as it could mask the psa result.  You need to find out if the last RT worked  and u will only be able to tell that with another 1 or 2 psa results.

If it works out that the RT didn't eradicate all the cancer cells then that would prob be the time to start the HT,  your specialist should advise on that , plus see what others say.

Steve

Hi, sorry to hear about this.

Looking back to your earlier posts, I see Post op PSA was 0.13.  However you don't say how long after surgery this was.  I had my PSA tested 3, 6, 9 and 12 months after surgery then every 6 months after that.

0.02 ng/mL is the level.at which it's considered a "recurrence", but if it never became undetectable, then levels above 0.01 are considered to be "persistent".  Nonetheless 0.2 is still a significant level.    If there was a gap of 6 months or more between first year PSA tests, the point at which it reached 0.2 was missed!

There are some questions you might ask the oncologist.

It's true that Hormone Therapy (HT) could reduce PSA and "mask" how advanced the cancer is, but once the lymph node was discovered and a decision made to use Radiotherapy, (RT) then HT could have been started as it sometimes is because HT can help make the RT more effective.  So it's not entirely clear why it wasn't started.

I can't say why the RT didn't work.  It doesn't always.  You can ask about that two.

It is still possible to have further treatment, i.e. a second course of RT, ( perhaps with HT), with a good chance of getting the cancer to the point where it may not cause any further problem in the future.  However, I've stopped using the word "curable" because there's never really any guarantee that it will disappear permanently.

Prostate cancer is slow growing even with a Gleason of 4 + 7, so some delay between treatments is worrying but not significantly.  

Thanks for your replies. He was on 3 monthly checks post rp. 

surgery Feb 18

April 18 0.13

Aug 18 0.13

Dec 18 0.31 got results Jan 19 after xmas

Feb 19 0.35

April 19 0.37

May 19 Imrt Psa 0.5

July 19 0.7

Hi Almondnut, sorry to read that PSA is rising. I presume he didn’t have whole pelvic radiotherapy because the PET scan showed only the lymph node?

I would think that another PET scan plus mpMRI should be carried out as a PSA of 0.7 is high enough to pick up any concentrated areas of recurrence.

My understanding is that a PSA of 0.2 or greater over 3 tests is considered recurrence not the 0.02 figure #Uroboros has quoted but I stand to be corrected if I am wrong in this.

 Did he have HT before the radiotherapy?

My PSA reached 0.7/0.8 before I started HT prior to radiotherapy and the above scans showed different areas of recurrence.

#Almondnut

Yes Ido4 is correct in that recurrence is considered if 3 consecutive test are 0.2 or above.  But these are NOT 3 monthly or 6 monthly tests.  If a test is 0.2 or above, then another test is carried out after a few weeks and if still above 0.2 again after another few weeks.

The 0.2 figure is significant but more so if after surgery the PSA becomes undetectable at some point, because then it is truly "recurrent".  However if after surgery the PSA never achieves undetectable then it is "persistent" which is another matter.  In which case, the 3 consecutive tests may not be relevant.

If it then subsequently rises, it's not only the level to which it rises that's significant, but also the PSAV, (PSA Velocity) the rate at which it rises. Traditionally, it is held significant if the PSA doubles in less than ten months.

I note your PSA jumped from 0.13 to 0.31 in 4 months and overall from 0.13 to over 0.3 in less than 10 months. 

However, this is now largely irrelevant since it appears all was being done that should have been done under the circumstances and also because  you have undergone further treatment. 

I also assume that when being originally investigated you had a bone scan, CT scan and MRI.  Depending on the power of the MRI it is likely that the scans you had couldn't detect any tumour smaller than 5cm, whereas the PET scan is more sensitive and/or after your surgery the tumour in your lymph node continued to grow.  This was why it may have been missed in the first place.

I trust that you may now receive a second course of RT and hopefully adjuvant HT

You might find this link informative,  click here

Well the three months wait is up. Psa gone from 0.7 to 1.82 since August. He is not on hormone therapy and Imrt to lymph node in May was his last treatment which clearly didnt work.See Onc on Wednesday. I am wondering why dont they give you  chemo at this stage to try for a cure while its still I hope only in lymph system and no bone mets. He is only 62. He has started with hip pain so v worried about that.  Any questions about treatment and scans we should be asking next week?

Thanks for all your replies much appreciated.

Hi Almondnut, sorry to see PSA is now 1.82. I would be asking the Onco about scans to see what is going on. A bone scan and an mpMRI would seem appropriate plus a possible PET scan. If he had radiotherapy to the node only I would asking whether further radiotherapy was possible if scans show it might be worthwhile.

After scans I would be looking to go on hormone therapy alongside possible chemotherapy to help the HT work longer.

Unfortunately neither chemo or HT will cure prostate cancer.

Hope this helps,

Thank you once again. What would we do without your input on this forum. Wishing you we!l.