Post treatment tests

User

Posted 09 Jan 2025 at 10:55

Hi,

I have locally advanced prostate cancer which was diagnosed in Dec 2021. I had a month of intensive radiotherapy in Apr 2022 and I am about to have my last hormone injection. The paperwork I signed at the start suggested that the aim was to cure. Apart from a tumour on the prostate, there was a small spread to a localised lymph node and the neck of the bladder.

Other than 6 mthly PSA tests (which show as undetectable) no scan has been completed to identify if the tumours have been eradicated following treatment. I have queried this and been told that they don’t undertake scans post treatment. When I queried getting a private scan, I was told that if a scan brought any value then they would be doing it.

I have recently found out that a friend with prostate cancer has just finished treatment in London and received a scan which confirmed the tumours had been eradicated. I am now questioning whether I should get a private scan or press the local hospital to do one.

I am also a little concerned that as I come to the end of the hormone treatment they are proposing to reduce the PSA testing to every 12 mths ( protocol apparently). This seems a dangerous time to take this action especially as my cancer is quite an aggressive type.

I would be interested to know of other peoples experiences, especially in relation to the scan.

Colin V

User

Posted 09 Jan 2025 at 21:21

I think Dave has made the point.

Basically the experience of doctors is that scans aren't that informative unless PSA is already high and rising. It is not a way of detecting if someone has cancer, it is a way of showing where it is if you know they have it. So if PSA stays low a scan tells them nothing and is actually very complicated and costly to do.

If your PSA does start rising, then there is a point in a scan because it is important to know whether that results from secondaries somewhere else in the body.

User

Posted 10 Jan 2025 at 00:47

Scans are normally only done after treatment if your PSA wasn't raised in the first place (so it can't be used to monitor treatment), or in the case of focal therapies where PSA is much more difficult to interpret and not always useful to tell if the treatment worked.

In most cases, PSA is more sensitive than any scan. Indeed, PSA can detect recurrence often well before any scan can find where it is.

PSMA PET scans do carry a radiation risk - equivalent to receiving about 4 years background radiation. So they're only used when there's a clinical need to do so, not out of curiosity.

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User

Posted 09 Jan 2025 at 11:35

Hi Colin.

Welcome to the forum, mate.

I believe, that following surgery or RT/HT, the guidance for PSA tests is at least every six months for the first two years, then annually.

I presume further scans would depend on those PSA results.

I'm just coming up to two years post surgery. I was T3a and Gleason 9 (4+5). I've had PSA checks every three months. I'm hoping that they will make them less frequent if my 2 yearly check comes back undetectable.

User

Posted 09 Jan 2025 at 11:56

Hi Colin,

Whilst the general recommendation for the frequency of PSA tests is every 6 mos; it does not seem to have a rational basis. Getting a PSA test every 3 months and PSMA Petscan every 6 months does not seem like a bad approach. I am unclear of any downside except expense.

My father age 91 has a locally advanced (Gleason score 5+5; Kn67 20-25%; and 2 lymph nodes involved) and we get PSA tests every 30 days. PETSCANs every 3-6 months. He is on ADT (Zoladex10.8 = Abiraterone). PSA down from 16.36 to 0.1ng/ml in 4.5 months. IGRT is to begin but he is reticent because of the side effects, both short term/long term. So it's an uphill battle. He is otherwise healthy. It is difficult.

I am wondering whether there is anyone on this forum in a higher age bracket and has faced a similar problem.

best wishes

User

Posted 09 Jan 2025 at 11:59

I don't know what a scan of an irradiated prostate would look like? Probably quite messed up. So it may have very little diagnostic value. PSMA scan would probably show you had a prostate, but you already know that. A PSMA scan would be useful for identifying mets, i.e. prostate cells where they shouldn't be. The tracer for PSMA scans is hard to produce so they won't do this scan without good reason.

A PSA test post treatment is useful. You know your PSA history and spotting changes could be helpful.

My GP is happy to give me a PSA test whenever I want, so I have been having mine six monthly since diagnosis. I have now been offered HT for four years, and with all the tests having been 0.2 or less I will probably switch to annual tests from now.

If a protocol says six monthly for two years post treatment, I would argue HT is treatment, and two years starts when the HT stops.

Dave

User

Posted 09 Jan 2025 at 12:08

Originally Posted by: Online Community Member

I don't know what a scan of an irradiated prostate would look like?

A very overcooked meatball?🍝

User

Posted 09 Jan 2025 at 12:45

Thanks for the info.

My PSA testing was every 6 mths from the start of HT, so stretching to 12 mths just as HT finished which doesn’t seem right to me. 2 years after HT has finished seems more sensible.

Cheers

User

Posted 09 Jan 2025 at 12:46

Thanks

User

Posted 09 Jan 2025 at 12:48

The comments in your last paragraph sum up my thoughts exactly.

not sure my doctors surgery would be so accommodating!

Cheers

User

Posted 09 Jan 2025 at 21:21

I think Dave has made the point.

If your PSA does start rising, then there is a point in a scan because it is important to know whether that results from secondaries somewhere else in the body.

User

Posted 10 Jan 2025 at 00:47

In most cases, PSA is more sensitive than any scan. Indeed, PSA can detect recurrence often well before any scan can find where it is.

PSMA PET scans do carry a radiation risk - equivalent to receiving about 4 years background radiation. So they're only used when there's a clinical need to do so, not out of curiosity.

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