PSA up 4 years post op

Insanus

I would get an radio oncologist and get zapped with little delay. Maybe 2 months ADT before treatment and 4 months after. Getter done.

DjinTonic

Hi Jim, I don't know why you weren't checking your PSA every 6 months given the EPE+ and SM+ in your path report. Have a PSA recheck to confirm the last reading, and consult with specialists (RO, MO) to get a salvage-therapy plan in place. Ask about advanced scans to help locate the source(s) of any recurrence.

Djin

__________________
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
Dry; ED OK with sildenafil
Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

JimBo096

Thanks for the replies. I'll make some phone calls on Monday. I really hope to avoid ADT. Not sure I'd agree to having that.

I'm not clear when radiation is advised, considering that recurrence supposedly doesn't occur until the PSA hits .2.

My cancer was stage 2 according to the pathologist, even though there was focal EPE present. I questioned the surgeon about that, and apparently the pathologist insisted it was stage 2.

Eonore

Hey Jim,

Sorry you find yourself in this situation. I agree with everything that has been posted so far. You need to move quickly. Your Psa is still low, and you have a great chance for a cure. Do not however discount the need for ADT. I have been through it, and it can be difficult. However it is temporary, and increases your chances of beating this thing once and for all. Many of us on this forum have had varying degrees of ADT, and can answer any questions about side effects. Now is not the time for half measures.
In addition, I do not know where you are, but if possible, get yourself to a top notch radiation oncologist at a cancer center of excellence.
As far as waiting for your Psa to reach some threshold before starting treatment, I believe that starting treatment as soon as Bcr is confirmed is the more modern view. Why wait and give yourself a greater chance at distant metatisies.

Southsider170

You probably should consult with your urologist on this, particularly as your PCP really isn't up to snuff as far as prostate cancer. It sort of marginal what you should do. Not a terribly ominous pathology and it has taken 4 years to get to this point which is still below the usual limits to call it BCR. But your PSA has started to rise and the doctors did think it was important enough to order the "ultra sensitive" PSA reading. Calling back and making an appointment with the doctor who cut you in the first place seems to be a prudent next step.

JimBo096

Unfortunately, the urologist who did the surgery is half way across the country from me. Maybe, I'll go see a local guy I know for a consultation. I'm really in no hurry to get radiation unless it's absolutely necessary. And an RO is most likely going to want to do the radiation because of the financial incentive. You gotta love for profit health care.

Southsider170

Profit might be part of it. But I think you are putting too dark of a motive on this. Radiation is a radiation doctor's forte, his vocation and livelihood. I think these guys really believe in the benefits of nuking their patients, and that they are really helping them.

Getting a local pecker checker to examine you, review your records and keep following up with you on this seems to be a prudent idea.

Insanus

Is that what you told the life insurance broker when he said you couldn’t be the beneficiary on your policy?

JimBo096

I just like the idea of getting an objective opinion from a doctor who will not be doing the treatment. I did that before I had surgery and I'll do that before having any radiation. I ended up having surgery at a large teaching hospital and medical school.

Southsider170

I can certainly understand your reasoning there. You don't know these individuals, and there are dishonest medical practitioners out there and I've seen them.

The first urologist I saw gave me the hard sell for radical prostatectomy and tried to make it seem as if I was taking food out of the mouths of his children if I said "no"

Gerard1954

Sorry you have to deal with this, Jim.

Believe me, I understand the temptation to stop testing -- I let my own, uh, "slide" a bit -- but neither your post-op pathology nor the nature of the disease itself affords that luxury.

Therefore, the first order of business is to get another test -- no more than 2 months or so out from your .08. It the result is higher than .08, you will unfortunately be a candidate for salvage treatment, though not necessarily on an emergency basis, depending on how much higher the number is and where your doc sets the trigger for intervention.

Meanwhile, I think you need a consult with an RO experienced in the treatment of prostate cancer. Do some research to track one down -- even if you have to travel a bit for the appointment. I get where you're coming from with the financial conflict-of-interest thing, but the hard fact is that according to prevailing standards of treatment, you're either at or very possibly heading toward intervention. The priority now has to be a good doc who can not only provide an expert opinion but can also perform expert treatment if necessary. That said: A) second opinions are always a good idea; and B) it's generally not wise to rush (or be rushed) into treatment decisions.

One last thing: I totally hear you about not wanting "to deal with this anymore." When you first get landed the diagnosis, all of your attention and energy turns to the immediate requirement -- surveillance, radiation, surgery, whatever. A lot of docs don't make clear, and it's not until later that you fully realize, you're in for the long haul. Really, it was this message board that brought that home to me.

__________________
YOB: 1954
PSA 4.4 -- Mar 2016; 5.9 Jan 2017; 7.7 Mar 2017
3T MRI of prostate -- April 2017; prostate found to be enlarged (79cc) with two potentially cancerous lesions, one PIRADS-3 and one PIRADS-4
Fusion biopsy -- August 2017; 14 cores taken, with two measured at Gleason 4+3, corresponding to the MRI PIRADS-4 target location
RALP at Johns Hopkins -- February 2018
Pathology report upgrades G4+3 tumor to 4+5. One additional cancerous nodule found, G3+4; organ-confined; margins clear, SV clear, LN clear
Continence: One pad for two months, then dry; ED: Resolved with Cialis
PSA less than 0.1: May 2018; Aug 2018; Dec 2018; Apr 2019; Aug 2019; Mar 2020

Prostatefree

Early detection early treatment all the way down unless you're considering no more treatment due to advanced age.

You should at least consult with an RO and create a plan. Together you can pick a time to react. If treatment appears inevtiable sooner is better than later in most situations.

As you know, delay and denial are the two demons of cancer.

I'll add a third. The "I don't wanna....." defense. Nobody wants cancer. Collapsing that into I don't want treatment is dangerous.

__________________
Born 1953; family w/PCa-grandfather, 3 brothers;
7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
1-15-21 PSA less than 0.02; zero club 4.5 yrs

Southsider170

Actually, delaying treatment often has a lot to be said for it, and not only for prostate cancer but for other cancers and other non-cancer related problems.

Keeping an eye on a situation, a patient can avoid the expense and trouble of treatment for a considerable length of time and sometimes forever. Even in the post treatment phase, if there is a sufficient amount of time between RP and a designated "acting" point for BCR, the doctor can determine that it is highly unlikely that the cancer will ever return big enough to be a problem.

JimBo096

Thanks for the replies. I'll get my PSA checked again in 2 months. I don't even know if I'll have health insurance then to pay for treatment anyway. Fun times ahead!