New to site but not to PCa unfortunately

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Evening all, I’m here on behalf of my husband and for moral support.

Quick overview - husband had RARP and extended lymph node dissection just over 4yrs ago. Gleason 4+3, T3a. Nodes were clear but positive margin. Post op PSA was 0.2. He completed adjuvant RT 4yrs ago come Christmas. His PSA has remained undetectable until now - it’s 0.2.

Oncologist requested a PSMA scan prior to arranging an appointment to see him in December but this has been rejected by the radiology department on the grounds that he’s not for surgery of RT. He’s now awaiting an urgent MRI of pelvis instead.

I have read about SABR treatment but without a PSMA scan I don’t see how that would be an option. I wonder if they’ll start him on HT depending on the MRI findings.

He is a fit and healthy 64yr old who still works and cycles daily. Thanks for listening.

Alwayshope 11 months ago

Hello Lexi26 and welcome. I hope we can give you the support you need and also help answer some of your questions.

The PSMA PET scan is good for showing up micro mets and any other sites anywhere in the body. It can be used when the PSA is as low as 0.2 but it is more accurate at the 0.5 level which is maybe why the radiology department are reluctant to offer it at the moment. Having SBRT may still be possible if the MRI or other scans show where the cancer is still lurking but if it is still in the pelvic area then this will depend on the dose he has already had during the salvage radiotherapy. There are other ablative treatments but not often offered within the NHS, more for the private sector. This video is a good starter for when to treat a recurrence.

https://youtu.be/ygZNfQhrrYc?si=RvlL4NSAaQtpaA1A

As far as other therapies are concerned then this will depend on whether a systemic approach is taken to try and kill the cancer or whether they think hormone therapy on its own is advisable. I have attached a link to a video which explains all the different options once a recurrence has been identified.

https://youtu.be/-RVVq0uDAEE?si=RQcqOzssBIfC6b_J

David2017 11 months ago

Hi Lexi26 , I think the explanation you have been given about a PSMA PET isn’t correct re surgery, but Alwayshope has got it right. PET’s are in great demand and in my understanding NHS guidelines for recurrent diagnosis are for 2.0 to be hit before you get on the list. Depending on the MRI I suspect your OH will be advised to go on HT initially. David

Best wishes, David

Please remember that I am not medically trained and the above are my personal views.

Lexi26 11 months ago in reply to Alwayshope

Thank you Alwayshope - those links were very informative, thanks for taking the time to share them.

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