psa level for referral to Oncology post Op

It's a very slow doubling time, 3 years. At the current rate it will be 3 years before you breach 0.2 and if PET scans are more accurate when you get to 0.5 that is going to be six years away. 

I think it is reasonable to assume you only had a few cancer cells in your body post prostatectomy, and that implies that it had not already distant metastasised. So RT to the prostate bed will probably kill whatever cells are growing there now. If it has metastasised I think with such a slowly rising PSA it would be in only one place (multiple distant meets would have generated noticeable PSA after the prostatectomy), and having RT to the prostate would not prevent later RT to a different area of the body.

So zapping the prostate bed now would probably cure your cancer. If it didn't you would probably have to wait about six years to be able to spot it and assuming it is in one or two places have more RT with curative intent.

If I were an oncologist (which I'm not, I'm a computer nerd) looking at my budget, I would probably not want to spend money for RT on someone with a very non urgent cancer. If I were a patient in your position I would probably agree with the oncologist that, though you almost certainly still have cancer, at the current rate it is probably 50/50 whether it will kill you before some other cause. If you were to leave this (obviously closely monitored) for another three to six years, yes you will have more cancer cells, but scans will be better and treatments may also be better by then. Though RT side effects are minimal, you will also have avoided them for three to six years. So on balance I would just keep having PSA tests every 4 months.

Edited by member 20 Aug 2024 at 14:32  | Reason: Not specified

I have been managed by oncology for years (don't trust GPs or Urologists once you don't have a prostate). I have also swapped from private to NHS since retiring. While I was private I had the luxury of seeing specialist prostate radiation oncologists for second opinions.

Waiting for a change in doubling time or 0.2 was the universal recommendation for my case by all the oncologists I have seen recently (even when money was not a consideration). The only difference in proposed treatment path was whether whole pelvis or prostate bed radiation would be recommended if I eventually needed it.

So don't dismiss lightly the impact of radiation to your nether regions especially if the trials say it's not going to make any difference giving it 5 years before you need it.

If you are high risk (G8+ and rapid doubling time) this post is not relevant to you.

Edited by member 20 Aug 2024 at 08:37  | Reason: Not specified

Saw the oncologist this afternoon. My case had been discussed amongst the team prior to my arrival. Because of my post op histology results (T3a, G3+4) together with the rate of increase of my PSA over the last year or so, they consider me high risk and recommend 33 sessions of RT to the prostate bed and lymph nodes, together with HT and to continue the HT for some time following completion of RT. I told them I am not keen on HT because of the side effects and whilst they acknowledge it is my decision, they strongly advise me to do it. Everything and all the risks were explained to me in detail and I wasn't rushed to make a decision on the spot. I was told a PSMA scan would be inconclusive at my stage and that it is best to zap the most likely areas. My gut feeling is to get on with it. Even if I go for a second opinion elsewhere, (they recommended UCLH) I know that I am bound for RT and that the length of time I take HT is in my hands anyway. Also, it doesn't suit me well to have to travel into central London for treatrment and reviews when all the West Herts facilities are within 25 minutes of my home. and to date, I have been super satisfied with their empathetic approach. There was a time when I thought that a PSA level of 1.9 would have been considered too low for SRT but clearly in my case and others on this thread with lower levels, it is not.

Peter

This is a dilemma because studies seem to show that it can be better to start salvage treatment while the PSA is still relatively low (e.g. below 0.5 or even below 0.25) but on the other hand, as the PSA grows there is more chance of identifying the precise location of the cancer on a PSMA PET scan and then targetting it more precisely, thereby reducing collateral damage.

Even Dr Scholz (an American expert on prostate cancer) seems undecided but you may find this video useful in highlighting some of the issues involved:

https://www.youtube.com/watch?v=X_FtOBTIOj0

Edited by member 19 Aug 2024 at 22:27  | Reason: Not specified

My oncologist basically agreed with KS25, with a PSA under 0.5 I was told scans can show nothing and weren't worth doing since he had to make decisions on treatment regardless.

Peter, have a look at the start of my profile,there are some similarities. I didn't have HT because it was thought to be toxic for a urethral stricture I was having treated. I was refused a PSMA at similar levels to yours and had the "educated guess" 33 sessions of salvage RT to the prostate bed. My PSA did reduce after SRT so something was in the bed , but the PSA did start to rise after SRT.

I am trying to avoid HT, but it may be looming. In hindsight the additional of HT may have been a benefit. I did have six months of Bicalutamide with my second course of SABR treatment to a cancerous lymph node. Not sure if that is an option for you, I have always thought that if the HT is too much to cope with I could stop it and face the outcome.

If the PSA rises after SRT there is now the option of a PSMA scan later and SABR treatment to a limited number tumors on the NHS.

Difficult decision,hope you make the right one.

Thanks Chris