Psa rising after RARP

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User

Posted 16 Jun 2020 at 05:27

we live in s.e.asia . Hubby (60)was diagnosed last july , Gleeson 3+4 . PSA before surgery was 5.6 , 5.1 , 7 , 4.9 . Post RARP Gleeson remained the same & margins supposedly all clear save for perineurial invasion . His RARP was in sept 2019. First psa check in nov was 0.05 , 2nd in feb 2020 was 0.09 & yesterday it was 0.25 . We are devastatated . Now we have second test scheduled in 3 weeks & then probably a PSMP pet scan. What is the way forward? HT or salvage radiotherapy ? Do they work??

User

Posted 16 Jun 2020 at 09:24

Sorry you're here.

I would suggest you push for a PSMA PET scan. 0.25 is a little on the low side - there's a chance the PET scan might not find the cancer at the low level, and some places would want you to wait until it was higher before the scan. If the histology found that the cancer had got out of the prostate via perineurial invasion, then it's almost certainly in the prostate bed, but the PET scan might pick up any that's got anywhere else, and in some circumstances such as pelvic lymph nodes, the radiotherapy target field can be adjusted to include them.

Salvage RT does work, more so when preceded with a PET scan. Sometimes it's given with HT, sometimes not.

Wishing you all the best in the circumstances, and do come back and ask anything else that springs to mind.

User

Posted 16 Jun 2020 at 13:16

Thank you for responding.Actually the urologist surgeon suggested the same that due to PNI some cells have escaped . I really hope its in the bed & nowhere else. Getting a PMSA Pet scan here is not a problem in fact the doc suggested it . Hubs has started working out he is a bit rotund but does brisk 5km walks everyday. Reading your experience i would say he would have to do more if he is put on HT & RT . Would love to join a zoom session if do one soon.

User

Posted 16 Jun 2020 at 16:05

Hi Calamansi,

it can work - my husband had his op 10 years ago but then a recurrence 2 years later meant that he needed RT and HT. 8 years on, his PSA is stable at or around 0.1 and for most of the time, the fact that he once had prostate cancer is just a dim and distant memory.

There are a few oncologists who say the patient doesn't need HT with their salvage RT but most are of the view that salvage RT is much more likely to be successful if HT is also given, even if just for a few months.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Jun 2020 at 23:48

Thank you Lyn, your reply is soo reassuring . About the HT are there horrible side-effects as the internet suggests? My OH is relatively healthy with no chronic illnesses , he is overweight but has recently discovered the joy of exercise He is determined not to be treated as a sick person.

User

Posted 17 Jun 2020 at 00:22

It varies from person to person and also depends on whether the onco recommends implants that stop all testosterone production or tablets, which just disguise the testosterone so the cancer can't feed off it. Some oncos will recommend 18 months with salvage RT, others say 3 years or none at all. It doesn't make people act sick though; some suffer with fatigue and muscle aches but I guess he went through a bit of that when he first discovered exercise?

There is little point you second-guessing right now as you don't know whether a) the onco will recommend HT b) if so, which type or c) how long for.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 17 Jun 2020 at 00:50

Unfortunately i didnt go to the appointment with my OH but he did say that the doc mentioned HT . Will go for the next appointment for sure .

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