PSA doubled; biochemical recurrence?

There isn't a 'might be' here - you are in biochemical recurrence. There isn't any great urgency from the medical point of view though as the standard approach will be to put you on lifelong HT to control the cancer and oncologists have different views about when to start the HT in these cases ... some will put you on HT when you get to 5, others would wait till your PSA reaches 10 or 20.

If your oncologist is suggesting that you have another PSA test in November and then a scan, that isn't a major problem - if your PSA rises a little more, there is more chance of the scan picking up the problem. If, on the other hand, your onco is just suggesting another PSA test in November and isn't offering a scan at that point then yes, push for a scan. If your hospital has PSMA scanning, great. It doesn't have to be a PSMA scan though - if your hospital has FACBC , I would go for that instead. If it comes back clear, you could consider paying for a PSMA scan as a follow up.

The debate is what difference a scan might make to your treatment options. If the scan picks up an obvious and isolated met away from the pelvic area, targeted RT might be possible. If the scan picks up activity in the pelvic area, your only option is HT, possibly with early chemo. If, as often happens, the scan doesn't pick anything up, you are looking at HT or gambling on waiting for the PSA to go higher and then repeating the scans. CJ's PSA went to 100 and still all his scans were coming back clear - when it did eventually show itself, he had multiple mets.

Edited by member 27 Sep 2022 at 22:47  | Reason: Not specified

From the little information we have on your diagnosis and subsequent, histology, it looks to me like your Consultant has adopted a very relaxed attitude in your case. I would have expected that he might have tried to rule out any reason other than cancer that might have accounted for such an increase in your PSA such as a UTI, by getting a culture urine test done followed as soon as practicable by another PSA test. If there was no reason established to account for your PSA level and it still remained of the same sort of order, I would have thought that an MRI or PSMA could be beneficial. If this resulted in cancer being found within the Prostate it might be possible to treat it with Focal Therapy or depending on where elsewhere it was found possibly with more RT or SRT depending on where and how extensive were any tumours seen.

Where tumour(s) is /are seen, I am inclined to the view of Consultants who want to treat as soon as possible. As they say, it's easier to treat an early small tumour than wait until this has grown larger and possibly spawned other tumours gaining additional heterogeneity in the process. So in some cases, early salvage treatment can prevent or delay the need for systemic treatment. In my case, after my first HIFU and with PSA gradually increasing again I was written up for HT again but declined it.

I paid for a 68 Gallium PSMA test privately - it was even more difficult in 2015 to get this scan on the NHS than than it is now. This showed that I had a small tumour in my previously radiated Prostate but not in an iliac lymph node as was previously supposed. After another MRI and a persistence by me to avoid HT, it was agreed to give me a second HIFU, which I had last December. Since then, I have had two PSA tests, both of these being 0.02. Interestingly, this is lower than my nadir of 0.05 after RT. So for me, the PSMA scan helped change my treatment from starting HT. It's still possible that at some time if the cancer gives concern I may yet have to accept HT but meanwhile the HIFU has at least deferred my taking it. (As long as you still have a Prostate, even a radiated one, there is always the potential for cancer to grow).

A PSMA scan, or if this is not available one of the other top scans, will not necessarily show all cancer or change treatment plans but it did for me as it has done for a substantial number of other men, so it is something worth considering. Of course every case should be treated individually and on its merits but some Consultants treat more aggressively or differently to others. In my case I was fortunate in being able to get the views from other hospitals who have been involved in my case.

Edited by member 29 Sep 2022 at 12:27  | Reason: Clarification