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Psa increase 6 moths after surgery

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User
Posted 08 Jan 2021 at 16:13

Have had prostatectomy end June 2020,  20 lymph nodes removed and seminal vessels removed no nerve sparing. Pathology report showed lymph nodes clear but positive margins and seminal vessel invasion.
First 3 month PSA was 0.038 and second PSA is now 0.159 as it has gone up the multidisciplinary team are having meetings to discuss next poss treatment. Waiting to hear what they suggest.

If they suggest radio therapy is it necessary to have hormones again especially after prostate has been removed. Has anyone had post op radio therapy without hormones any advice appreciated, thanks.   
Dreading going back on the hormones if I have too and even more concerned if I need too due delays because of COVID. Prostatectomy was delayed last year due to COVID.!!! 
Thanks John.

User
Posted 08 Jan 2021 at 21:22

Hi John

Sorry for your situation.

Different oncologists have different views of hormone therapy during salvage or adjuvant radiotherapy. I rather suspect that with G 4+5, they are more likely to recommend hormone therapy, but it's up to you. Ask your oncologist how it will change your odds, and then you make the decision weighing side effects against chances of longevity. You might also consider a shorter run of radiotherapy rather than none - the important part is the neoadjuvant (before radiotherapy), during, and after radiotherapy (adjuvant), but becoming less important as it tails off into the distance. So you might look to do 6 months with the radiotherapy at around 3 months.

Which side effects caused you the most problems? There are things which can be done to reduce some side effects, and you should consider exercise mandatory while on and recovering from hormone therapy.

User
Posted 08 Jan 2021 at 21:23

With a positive margin you were always at more risk of a recurrence, good news is you are more likely to get a durable remission from the radio therapy. Also the involvement of the seminal vesicles makes RT more likely.

You can enter your stats here to get an idea of the likelihood of a durable remision post RT.

https://www.mskcc.org/nomograms/prostate

 

 

 

Edited by member 08 Jan 2021 at 21:24  | Reason: Not specified

User
Posted 08 Jan 2021 at 23:37
They won't force you to have HT against your wishes but the data shows that salvage RT is more effective with HT than without. If you have a second opportunity at a chance of remission, it would seem sensible to give yourself the best chance possible. Having said that, my husband hated every second of the HT and stopped early - that was 8.5 years ago so no evidence at this point that he has ruined his chances!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 08 Jan 2021 at 21:09

John 

I did have salvage RT without HT three years after RARP, it was thought the combination would have a detrimental effect on a urethral stricture. Three and a half  years on from SRT and the cancer has come back. We are assuming the cancer was not all in the prostate bed.

There are some members whose treatment is more recent and their PSA has risen like yours or never gone as low as hoped.

It would be good to get one of the tracer type scans, if you can, but with the PSA at such a low level it may not find anything.

Thanks Chris

 

User
Posted 08 Jan 2021 at 23:47

My husband’s RALP and extended pelvic lymph node dissection was end of July. His post op PSA was detectable, 0.2. He was referred to an Oncologist who recommended 33 fractions of adjuvant RT without HT.

When I questioned this he said HT would have no added benefit to him (obviously every patient’s case is individual).  He completed his treatment 3 weeks ago.

Best wishes. 

 

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User
Posted 08 Jan 2021 at 21:09

John 

I did have salvage RT without HT three years after RARP, it was thought the combination would have a detrimental effect on a urethral stricture. Three and a half  years on from SRT and the cancer has come back. We are assuming the cancer was not all in the prostate bed.

There are some members whose treatment is more recent and their PSA has risen like yours or never gone as low as hoped.

It would be good to get one of the tracer type scans, if you can, but with the PSA at such a low level it may not find anything.

Thanks Chris

 

User
Posted 08 Jan 2021 at 21:22

Hi John

Sorry for your situation.

Different oncologists have different views of hormone therapy during salvage or adjuvant radiotherapy. I rather suspect that with G 4+5, they are more likely to recommend hormone therapy, but it's up to you. Ask your oncologist how it will change your odds, and then you make the decision weighing side effects against chances of longevity. You might also consider a shorter run of radiotherapy rather than none - the important part is the neoadjuvant (before radiotherapy), during, and after radiotherapy (adjuvant), but becoming less important as it tails off into the distance. So you might look to do 6 months with the radiotherapy at around 3 months.

Which side effects caused you the most problems? There are things which can be done to reduce some side effects, and you should consider exercise mandatory while on and recovering from hormone therapy.

User
Posted 08 Jan 2021 at 21:23

With a positive margin you were always at more risk of a recurrence, good news is you are more likely to get a durable remission from the radio therapy. Also the involvement of the seminal vesicles makes RT more likely.

You can enter your stats here to get an idea of the likelihood of a durable remision post RT.

https://www.mskcc.org/nomograms/prostate

 

 

 

Edited by member 08 Jan 2021 at 21:24  | Reason: Not specified

User
Posted 08 Jan 2021 at 23:37
They won't force you to have HT against your wishes but the data shows that salvage RT is more effective with HT than without. If you have a second opportunity at a chance of remission, it would seem sensible to give yourself the best chance possible. Having said that, my husband hated every second of the HT and stopped early - that was 8.5 years ago so no evidence at this point that he has ruined his chances!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 08 Jan 2021 at 23:47

My husband’s RALP and extended pelvic lymph node dissection was end of July. His post op PSA was detectable, 0.2. He was referred to an Oncologist who recommended 33 fractions of adjuvant RT without HT.

When I questioned this he said HT would have no added benefit to him (obviously every patient’s case is individual).  He completed his treatment 3 weeks ago.

Best wishes. 

 

 
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