PSA doubling time and what next

A PSMA scan is certainly the thing to push for to ensure the RT is properly targeted. You wouldn't want HT to start until after your scan as you want to be able to see any cancer spots in all their glory before they start shrinking with the HT.

Hi Dave, thanks for the comments. I'm hoping to have any saunas etc done before June and get some form of treatment done.

I have Dr google to name ref the doubling time. I read many reports that advised that doubling time of <12 months not ideal but <3 months high risk for a more aggressive recurrence. That said there are so many differing opinions from the experts....

Cheers 

Thanks Chris. 

The interesting thing is that HT has not been even mentioned to me as a course of action yet. Just radiotherapy. I'm going to discuss this when I have my next meeting......not that I want HT but it might be a nenefit to me now?

Cheers

I have read that the PCa cells thrive off of testosterone so I am thankful that I'm taking every step towards curing it. But I would probably feel different if (when??) there were side effects.

Hi Guys,

Just a short update. Taking some advice from the community I have been in contact with hospital to try and find out how to progress and highlighting the heightined state of anxiety.

Having found out my appointment with oncologist is booked for 30th May, I managed to get a call with him yesterday. He has said that, although PSA values can jump around a bit, due to the consistent rise post surgery from 0.1 to 0.15 to 0.22 and doubling time of 10 weeks it suggests that the operation in Nov 2023 has not removed all the cancer.

2 options

1) wait until the psa gets to a point where there are symptoms or to around 10 and then do HT

2) do radiotherapy to the hormone bed now

He believes doing a psma pet scan at my psa level will likely not show anything and he would not consider doing it until psa reaches 0.5 or 1.

He also doesn't believe HT would be of benefit to me now at a low psa level of 0.22 as summarised in point 1 above recommendation 

He believes if I do radiotherapy now, I have about a 50/50 chance of it curing me now....the risk being if it has spread outside the prostate bed area.

Its such a headache (the chicken or the egg syndrome!!)but I don't want to wait to June or July, have more scans, then possible be waiting while cancer cells continue to grow and prosper without treatment.

I've informed him I'd like to proceed with radiotherapy and he is now organising same. As soon as I made the decision I felt relief but now my head is spinning have I 'shot my bolt' too early lol.

He did say that obviously there are other treatment options should radio not be effective but I think apart from the side effects of RT which im fully aware of, at 51 yrs old it's worth it.

Any thoughts or comments would be appreciated.

Cheers

I'm not surprised your head is spinning, it must be like going through diagnosis all over again. 

You mention that your histology was PT3B with positive margin and cancer cells present, if I got that right. In my layperson's opinion I'd say your oncologist has a really good idea as to where the cancer is and where to target the radiation. As you're well over (or will be) the threshold for a scan, it would be nice to have that to confirm its location. 

I can understand how you feel about HT, I was the same, but with your histology and doubling time, can you ask for HT? Also, did you try running the nomogram from Peter's post?

I went for early SRT without HT in 2022 and so far it has paid off, but that nomogram sows seeds of doubt in my mind. 

It's a difficult decision and I wish you good luck. 

Kev.

Hi Adrian,

I think it's a bit of me pushing and the rate of change. Part of oncologists concern at my meeting on 2nd Feb was that although my PSA had risen at that time from 0.1 to 0.15, he said these readings can bounce around a little and it was not clear evidence that cance still there until consecutive rises or PSA above 0.4. He had asked urology to refer me back to him when mh PSA went above 0.2. I think with the fact it moved to 0.22 in around 6 weeks that he has said in gives clear evidence now to suggest cance still there and rate if change a little concerning.

The other thing resonating in my head was something the surgeon said to me at my post surgery review in beginning of Jan. He said there were cancer cells on the bladder neck and that he could not take any more away during surgery or would have made me incontinent. When I asked him then were there some cells possibly in the prostate bed in that area he said, no they are on the bladder neck. 

I think with high risk features of PT3b with ENE, neurovascular bundle invasion, seminal vesicles basesninvasion and bladder neck invasion, the RT can't do me any harm. I'm physically fit and well and if there are cells elsewhere, there will be a treatment plan for that.

Don't like an option of waiting for symptoms or high enough PSA for HT as could spread to distant locations in the interim.

I've 4 great kids and wife to look after so want to tackle this head on if I can positively.

Your advice is giving me thinking space which I that you for 😊

Thanks Chris,

I know we have to remind ourselves that these levels of PSA are very low and very treatable. I think you are still in  good place after 5 years. Good luck with next steps....

Cheers