Hi Sr Sailor-
It would help if you'd include your diagnostic and treatment info in your signature. From what I can understand from your post, your PSA has now passed the nadir+2 level after the conclusion of your adjuvant ADT (which followed an attempt at curative treatment with IMRT with an SBRT boost)- is that correct?
If that's correct, the next step is to determine whether the biochemical recurrence is:
• a local recurrence, and/or
• a distant recurrence, or
• not a clinical recurrence at all.
You are correct that a PET/CT scan would be a good tool for doing that. There are many kinds of PET scans. The one you mentioned, NaF18, is pretty good, covered by most Medicare, and widely available, and with a PSA over 2, should tell you what you need to know. There's a C11 Choline PET that is sometimes covered by Medicare but only available at the Mayo Clinic. C11 Acetate is similar but is not
covered by Medicare or insurance and is only available in a few places. There's a new generation of PET scans (e.g., PSMA) that is only available in clinical trials in the US but seem to be very good. NIH has a terrific and FREE clinical trial. There are also a few PET/MRIs out there, which are very precise. If you tell us where you are, we may be able to suggest a place. It is important that you do not have any hormone therapy before such staging, as it will interfere.
If they detect a local recurrence: something in the prostate or nearby, you can have a biopsy to confirm it and possibly have focal brachy, focal SBRT or cryo to get rid of it. It may be treatable in the pelvic lymph nodes too.
If they detect a distant recurrence and it is only a couple of spots, you may want to have SBRT on them. Often, that seems to at least slow it down.
If they don't detect anything, you may be having urinary retention or prostatitis that is raising your PSA from benign sources - again, a prostate biopsy (read by someone expert at that sort of thing) can help, an MRI or CT may show obstruction that can be removed, and sometimes antibiotics will bring it down. There's a diagnostic test called CellSearch that looks for circulating tumor cells. If all of that is negative, hormone therapy is diagnostic - if the PSA goes away on hormone therapy, it is most likely micrometastatic. However, the decision to start permanent (intermittent or continuous) hormone therapy is not automatic in such a case - there may be no benefit to early use until the PSADT is rapid or there is clinical evidence of progression.
You have to take all this one step at a time.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 7 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA
•PSA now: 0.5
No lasting urinary, rectal or sexual side effects, except loss of ejaculate