When to Move from Surgeon to Radiologist/Oncologist

User

Posted 13 Jan 2025 at 21:31

I had the Robotic Prostatectomy in December 2020. It was Gleason 9, with no sign of spread outside the prostate. My first several PSA following the surgery were 0.01, the 0.02 two years after surgery, 0.04 three years after surgery, and presently 0.07 (four years after surgery). My Urologist seems to think it may still be leftover benign prostate glands, and thinks I should monitor it until it hits 0.2, when the PSMA Pet Scan may pick up any spread. With the Gleason 9, given the alarming increase, I think it may be time to seek the services of a Radiologist Oncologist, as it seems concerning to wait until it has increased that much, given that it is Gleason 9. My questions are: 1. Any chance it is benign prostate glands, 2. Should I follow my current doctor's instructions to wait until/if it hits 0.2, 3. Should I start seeing a Radiologist Oncologist? Any thoughts would be greatly appreciated. Thanks.

Edited by member 14 Jan 2025 at 02:17 | Reason: Not specified

User

Posted 13 Jan 2025 at 23:16

I would get a referral to an oncologist. You have finished with the urologist as far as treating the cancer is concerned (although you might still need them for treating some treatment side effects). Oncology are unlikely to do a PSMA PET scan before it hits 0.2, but they might well offer to radiate the prostate bed, which given your very low PSA after prostatectomy and gradual rise, is most likely where the cancer is. They might offer to include the pelvic lymph nodes too.

Edited by member 13 Jan 2025 at 23:17 | Reason: Not specified

User

Posted 13 Jan 2025 at 23:36

I'm not a medical professional, so my opinions are just from a lay person, the opinions of your medical professionals are of more value than mine.

Small PSA numbers are subject to noise. However yours does seem to have a regular pattern to it. (I assume 0.4 should be 0.04). You seem to have a doubling time of 1 year. Benign prostate cells would not be increasing so consistently, it would be more likely they would be the same from the day after surgery and stay the same forever (with some random noise). With your latest PSA being 0.07 your next one in a years time is on track for being 0.14 that is taking you above the level of random noise. I think having a PSA test every three months would put you in a better position for knowing if this is a genuine increase. You may have to arrange these PSA tests privately and if it is from a different laboratory they will not be comparable to the ones you have had so far.

Dave

User

Posted 14 Jan 2025 at 09:00

My Gleason was only 4+3, my histology was poor and my post op rise was quicker than yours. As already advised get a referral to an oncologist, that way you are already in the system. In my day at 0.1 you would come back under the care of the hospital and at 0.2 action was instigated, I think the wider use of PSMA scans have affected the 0.2 threshold.

I was frequently told my consultant had numerous patients who peaked at 0.1, but unfortunately I didn't, my profile lists the progression of my PSA.

Hope it all goes as well as it can.

Thanks Chris

User

Posted 15 Jan 2025 at 22:12

Checkout my profile not a G9 but still not had salvage RT 9 years after diagnosis, latest PSA 0.13. oncologist has said PSMA scan at 0.2. previous one at 0.07 ISH showed nothing.

User

Posted 16 Jan 2025 at 21:27

Thanks for everyone's information. I am glad I found this site, as I know of no one else to ask about it. After the responses, I am going to be retested in three months and am setting up an appointment with a Radiologist Oncologist.

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