Managing Advanced Prostate Cancer

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Hi fellow sufferers,

I had a prostatectomy in September 2021. Unfortunately my post PSA level was 0.2. A year later my PSA has risen to 0.4. It’s now time for further treatment. I had a PSMA PET scan which found a micro metastasis on one of my lumber vertebrae, however a subsequent MRI scan did not find anything. I’m now in a situation where I can’t see a clear way forward. This is very worrying because although the scans have not identified any cancer cells anywhere else other than my vertebrae it’s being suggested that I have radiotherapy on my Prostate bed and Hormone therapy. I get the impression that this is just a belt and braces approach without knowing what to do. Has anyone else out there been in this position?

Grundo over 2 years ago

Hi DTM

Difficult one I must admit. I agree with your assessment.

PSA crept up marginally, surprising been picked up in the vertibrae.

If it was me I would probably hang on for a bit and possibly consider getting a second opinion.

Only my opinion, doesn't mean the right thing to do, see what others say, keep us posted

Best wishes

Steve

Ido4 over 2 years ago

DTM,

I had aggressive recurrence 1 year after prostatectomy. My PSA went from undetectable to 0.7 within a short period. I had an F18 choline PET scan and an MRI. The PET scan picked up recurrence in seminal vesicle remnants and the MRI picked up recurrence on the prostate bed. Did they use a tracer with your MRI? My oncologist strongly suspected I had micro metastases but after hormone therapy plus salvage radiotherapy I still have an undetectable PSA. I dread the day that is no longer the case.

Now to your situation. You have a few choices.
1. Start hormone therapy now and be on it for life intermittently or permanently. Is there an opportunity to use SABR (or cyber knife) to target the vertebrae met?

2. Start hormone therapy and have the salvage radiotherapy.

3. Wait until your PSA rises further to an agreed level and repeat the scans to see what is happening and then decide on treatment.

If you decide to have any radiotherapy I would definitely want them to target the vertebra as well.

I hope this is helpful.

Ido4

Dennis the menace over 2 years ago in reply to Grundo

Hi Steve, My latest PSA result is 1.0 having increased from 0.4 in 3 months. My Oncologist admits that there is no right or wrong answer on what to do next. However on balance we’ve agreed to go for another PSMA scan to see if the cancer has spread. If it still only on my vertebrae then repeat the MRI scan and hopefully it will be detected so that SABR treatment can be implemented. As long as this doesn’t take too long I’m comfortable that this is the best option at this time.

Thanks for your input, much appreciated.

Den

Dennis the menace over 2 years ago in reply to Ido4

Hi Ido4, I’ve been refused SABR because the MRI scan showed nothing in my vertebrae, and they can’t zap something they can’t see.

So we’re going for your option 3 with the aim of finding the tumour so that it can be zapped using SABR.

I’ll keep you posted.

Appreciate your input.

Den

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