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  • PSA increased to .072

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    Old 07-27-2022, 06:34 AM   #16
    DaveinMaryland
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    Re: PSA increased to .072

    I had an RP in May 2017. Gleason 3+4, positive margin, 3+3 at the margin. RP done at Hopkins. 1 year later PSA was .1. Underwent IMRT January to March 2019, with a 6 month Lupron shot given in December.

    I had very little side effects from the Lupron or the IMRT. The only side effect from the Lupron was loss of libido - no sex drive whatsoever. They could have passed a law requiring all women to not wear clothes and my only reaction would have been "Won't they get cold?" This went away about 9 months after the shot.

    The only side effect from the radiation was a bit of fatigue about 3/4 of the way through. It was what I call an energy fatigue. I would be going along doing my normal stuff and would run out of energy. This cleared up shortly after the radiation ended.

    3+ years later no additional side effects. I had ED before the surgery so I can't tell you anything about recovery on that.

    I did drop weight and upped my exercise and I think that was a big factor in minimizing side effects. My doc said I was the poster boy for treatment and side effects.

    I was retired for the radiation treatment so I had time to up my exercise. Nothing strenuous, just a lot of flexibility stuff and gentle motion stuff that worked up a sweat for 30 to 45 minutes (look up eccentric exercise) and walking 1 to 2 miles a day.
    __________________
    Dx at age 63 March 2017
    Prostate Cancer 3+4 Open RP May 2017
    PSA detectable May 2018, single digit .1 2 digit .06
    August 2018 2 digit .07
    November 2018 2 digit .10
    6 month Lupron Shot Dec 2018
    Salvage Radiation Jan - Mar 2019
    Testing every 6 months, undetectable since then.

     
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    Old 08-04-2022, 10:24 AM   #17
    mhammes
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    Re: PSA increased to .072

    Hello all,

    Just an update that I went up to Sloan Kettering recently and met with one of their ROs. She recommended waiting until PSA hits .2 and then do a PSMA scan (which apparently likely be covered by insurance at that point) to try to pinpoint things before starting radiation. My understanding is that there would still be a fairly low chance of anything getting picked up at .2 but I am weighing this advice vs. starting earlier. I'm also trying to get clear on the risks and benefits of radiating just the prostate bed or bed and lymph nodes (which I understand can have higher risk of side effects.) I will go back and see my RO at Hopkins in early Sept. after getting another reading.
    __________________
    Born: 1965 PSA: 6.5 at 10/16
    Biopsy 2/17 Gleason 3+4
    Radical Prostatectomy 5/17, prostate biopsied at Gleason 3+4, no positive margins, no spread to seminal vesicles
    PSA readings 5/17-1/21 undetectable to .01
    1/21 PSA = .03
    7/21 PSA = .045
    11/21 PSA = .049
    2/22 PSA = .056
    5/22 PSA = .072
    Decipher result 1/22 = .72

     
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    Old 08-04-2022, 01:18 PM   #18
    duckinator
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    Re: PSA increased to .078

    I suggest watching Dr Eugene Kwon's 3 part series / videos on you tube. He makes a strong case for scans to determine exactly what/where the cancer is before planning a treatment.
    __________________
    PSA at 4.2 10/2019
    Diagnosed PCa 11/21/2019 small volume 3+3 thus AS

    2021 - PSA 4.72
    3TmpMRI then fusion biopsy
    3+4 in a 7mm lesion , 3+4 nearby, and 3+3 on other side.

    Started SBRT 6/2/2021

     
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    Old 08-05-2022, 04:38 AM   #19
    Prostatefree
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    Re: PSA increased to .078

    Quote:
    Originally Posted by mhammes View Post
    Hello all,

    Just an update that I went up to Sloan Kettering recently and met with one of their ROs. She recommended waiting until PSA hits .2 and then do a PSMA scan (which apparently likely be covered by insurance at that point) to try to pinpoint things before starting radiation. My understanding is that there would still be a fairly low chance of anything getting picked up at .2 but I am weighing this advice vs. starting earlier. I'm also trying to get clear on the risks and benefits of radiating just the prostate bed or bed and lymph nodes (which I understand can have higher risk of side effects.) I will go back and see my RO at Hopkins in early Sept. after getting another reading.
    See my post, Promising therapy for BCR post RP.

     
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    Old 08-07-2022, 07:47 AM   #20
    mhammes
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    Re: PSA increased to .072

    Quote:
    Originally Posted by duckinator View Post
    I suggest watching Dr Eugene Kwon's 3 part series / videos on you tube. He makes a strong case for scans to determine exactly what/where the cancer is before planning a treatment.
    Thanks for the suggestion - I watched these this weekend, very interesting. One of the things he notes in Part 2 is that for those who have recurrent after RP, 33% of the time the recurrence is localized, whereas 45% of cases are metastatic. On it's face that would be a strong case for imaging before treatment. However, I wonder how these numbers correlate to time from RP to recurrence as well as the pathology at time of RP. I would think that the pathology in particular would be an important factor, with lower Gleason scores, no margins, etc.. would skew to a higher percent for localized disease. If he is taking a random sample there could be a large number who had a higher risk pathology which I assume would lead to a great liklihood of metastasis. In any case, I am definitely going to watch this again before my next appt with my RO in September, and will discuss some of these points with him.
    __________________
    Born: 1965 PSA: 6.5 at 10/16
    Biopsy 2/17 Gleason 3+4
    Radical Prostatectomy 5/17, prostate biopsied at Gleason 3+4, no positive margins, no spread to seminal vesicles
    PSA readings 5/17-1/21 undetectable to .01
    1/21 PSA = .03
    7/21 PSA = .045
    11/21 PSA = .049
    2/22 PSA = .056
    5/22 PSA = .072
    Decipher result 1/22 = .72

     
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    Old 08-07-2022, 07:57 AM   #21
    mhammes
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    Re: PSA increased to .072

    Quote:
    Originally Posted by Prostatefree View Post
    See my post, Promising therapy for BCR post RP.
    Thanks for referencing - this is what my RO is recommending for strong consideration if (once) my PSA reaches .1. While nothing is ever straight forward with this disease, my issue really seems to boil down to a couple of options: 1) Go ahead and treat early, i.e. at .1 or slightly higher, which I'm likely to hit this Fall or by end of year based on my uPSA trajectory, with radiation to PB and lymph nodes + 4-6 months of ADT OR 2) wait until PSA reaches .2 and hope that a PET scan helps pinpoint the disease. While clearly the notion of treating the PB and finding out later there was metastasis is distasteful, I am leaning towards option 1 as I feel that waiting for the PSA to double to .2 gives time for metastasis, and my understanding is that PSMA scans have only a 25% change of picking up the disease even at .2.
    __________________
    Born: 1965 PSA: 6.5 at 10/16
    Biopsy 2/17 Gleason 3+4
    Radical Prostatectomy 5/17, prostate biopsied at Gleason 3+4, no positive margins, no spread to seminal vesicles
    PSA readings 5/17-1/21 undetectable to .01
    1/21 PSA = .03
    7/21 PSA = .045
    11/21 PSA = .049
    2/22 PSA = .056
    5/22 PSA = .072
    Decipher result 1/22 = .72

     
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