Treatment for biochemical recurrence

High Big Col.

It's a blow, just when you think you are home and clear you find yourself back on the rollercoaster. It would be helpful if you could add the journey you have been on so far such as TNM, Gleason....as further treatment options can depend on this. I see that you have already had radiotherapy so this option is usually ruled out for a second time to the prostate. Going on to Bicalutamide could imply that you are also going onto a monthly, 3 or 6 monthly hormone injection to reduce your testosterone to try and put the cancer into hibernation. As you have already had scans which don't show up anything then there is a question mark as to where the cancer is lurking. Have you had a PSMA PET SCAN as this is more sensitive at picking up mets? Look forward to hearing from you.

As an addition I have put a link with some information which might be useful for background reading.

https://www.cancer.org/cancer/types/prostate-cancer/treating/recurrence.html

My husband is currently working through the options.

No scans yet but I will update my profile....my next oncology appointment is 4th April. I was also on 6 monthly injection of prostap pre radiotherapy does this control psa or tetesterome or both ?

Hi Big Col.

Prostap (ADT - Androgen Deprivation Therapy) and Bicalutamide (First Generation antiandrogen) both work to reduce your testosterone, but in different ways. This then removes the 'food' from the cancer which can result in a drop in PSA. What the hormone therapy does not do is actually kill the cancer cells, but is very useful at putting them into hibernation. There are different types of hormone therapy (Second Generation Antiandrogen Therapy) which work in other ways to reduce testosterone but they are also usually used in conjunction with the injection as well. In order to kill the cancer cells you are looking at radiotherapy, chemotherapy, cryotherapy, nuclear therapy..... What order you are given different treatments and timing is down to the experts, but it can also be determined by where you live and the equipment available in your area.

Thanks  a bit clearer  now I have updated my profile for staging etc.

Thanks for that Big Col.

Looking at your stats you have a couple of issues. Firstly, you have had a nephrectomy, so whilst you are starting hormone therapy I would ask that the creatinine and eGFR are checked regularly as it could be affected. You have N1, so lymph node involvement which I presume was initially zapped but the lymph nodes act as a superhighway for metastatic spread so ensure that this is looked for in the wider area, not just the pelvic area.

Thanks the ct scan I had last November showed  my remaining kidney is doing really well. No spread to other organs or areas...I didn't think they scanned my liver though. 

My husband almost lost a kidney at the start of his prostate cancer journey and now it only has partial function so we keep a close eye on them. His diagnostic centre will not use contrast when he has a CT or MRI scan as his creatinine is consistently above 1.3 - it depends on what contrast is used.

Thanks for that information 

Hi are psma scans available in all areas?