Probable Reoccurence

Hello All - have not been posting on the forum for a few months but have kept up. For the past six months or so, I have been having my routine PSA tests and it appears my PSA is once again rising. It started at 0.1 a couple of months ago and latest PSA is 0.2. My urologist wants me to wait another three months to see if it goes up or stays at 0.2 then he said "we may want to consider radiation therapy".

I'm a little bummed about it given my pathology results after robotic surgery indicated cancer cells did not escape the capsule and my margins were clear.....really thought I had this thing conquered but apparently not. I'm not happy with the hospital complex my urologist goes with (Wellstar Medical in Marietta, GA) and have decided if I am to undergo RT I am going to go with Winship Cancer Centers which is a branch of Emory.

So a question - I feel like I'm treading water here just waiting for another PSA in three months which I'm pretty certain will be .2 or higher. I have researched radiation oncology doctors at Winship and wanted to know if you guys thought it would be imprudent of me to seek an appointment in order to lay out the whole saga of the past 2 years and see what he says......or do I just sit here until next PSA test and when my uro says we want to go to radiation break the news to him I'm going somewhere else other than the hospital he's affiliated with?

Diagnosed 12/15 after three PSA's of 7.4
Preop biopsy - 12 cores: 2=90% 1=35% 1=10% 1=30% 1=20% Remainder benign
All cores rated Gleason 6 (3+3) except 1 90% core which was Gleason 7 (4+3)
Post Op Path - Overall Gleason lowered to 7(3+4), gland 30 -40 % involved, one tumor confined to gland, cancer confined to gland, margins clean, 8 lymph nodes all clean, no seminal vessel invasion, no EXE.

Sorry - thought for sure I was getting the signature thing down.

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Diagnosed 12/15 after three PSA's of 7.4
Preop biopsy - 12 cores: 2=90% 1=35% 1=10% 1=30% 1=20% Remainder benign
All cores rated Gleason 6 (3+3) except 1 90% core which was Gleason 7 (4+3)
Post Op Path - Overall Gleason lowered to 7(3+4), gland 30 -40 % involved, one tumor confined to gland, cancer confined to gland, margins clean, 8 lymph nodes all clean, no seminal vessel invasion, no EXE.

I'd be layin' out the whole saga to the RO of my choice right now.

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PSA 2010 thru 2014...4.0 +/- .7
Dx 12/14 @ 56 yo...2 cores G6 <5%, 1 core G6 20%, 1 core HGPIN.
RALP 11/25/15...3+4. 3 to 5 mm surgical margin 15% involvement pT2+
PSA's....2/16-.01...4/16-.00...7/16-.00...10/16-.01...1/17-.01...4/17-.02...7/17-.02
10/17-.02...01/18-.05...03/18-.014...04/18-.02...07/18-.047

Here's one more vote for seeing an RO now. As part of the consult with the RO you can ask for another PSA sooner than the one your uro has ordered to help both you and the RO decide on further treatment. If your PSA is confirmed at 0.2 starting salvage radiation sooner than later is a good idea because the probability of successful treatment is better at lower PSA.
Jim

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Age 72
-2002-PSA 9.4, 5 of 10 cores 30-50%
-RP 2002 PT3B N0 MX Gleason 3+4 75% left lobe small focus rt lobe
-PSA low 0.01 slow rise to 0.4
-SRT 2010 1 lymph node targeted. Casodex during SRT
-PSA 0.00 thu 2014
-0.02 Oct '14; 0.04 Apr '16; 0.51 Jan '17; 2.46 Jan '18, 4.19 Apr '18; 6.62 May '18 start Firmagon; PSA 0.45 Jun; 0.08 Jul '18; 0.03 Aug '18

Forget about 0.2 as a benchmark. It is outmoded. You should be treated at the lowest possible PSA where the pattern is consistent. I think it's a great idea to talk to an RO right away.

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Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Yes.you should be able to call the hospital where you had your surgery, ask for the “Slide Room” and tell them you need the surgical slides sent out. They’ll send you a form to sign, it’s easy. But first speak with the RO’s assistant, who will tell you what’s needed. Some RO’s only need the pathology report. It’s the major hospitals/Cancer Centers that more often want their own pathologists eyeballing the slides.

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I am not a doctor, just another guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08
Decipher test, low risk, .37 score
My story.... tinyurl.com/qgyu3xq
My PSA History - /drive.google.com/file/d/1ltbG8x-iyH3k9pEltudhXt9u1krRwJSH/view?usp=sharing

Good decision. Got similar advice from HW veterans and was able to start HT and SRT while psa was .14, six months after surgery. Just two more treatments, then the wait for testosterone to recover. To prepare for treatment, try to get as fit as you can and stay active — at least walking 3+ miles a day — as the people offering counsel above thankfully advised me — made the journey much more tolerable.

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Age 76, Dx at 75
Psa 7/13=8 with BPH, 9/17=20.44
7/20/17, Biopsy, 5/12 cores PCa all right side, Gleason 4+3
Laparoscopic surgery MSKCC 10/31/17, left nerves spared, pathology T3aN0, G4+3, focal EPE, negative margins,
Continent but ED
12/14/17-psa 0.10; 1/25/18-0.11, 3/5/18 - 0.12, 3/30/18 - .12, 4/30/18 - .14, bone scan and MRI negative
6 months Lupron 4/30, SRT 7/2-8/28 (40 treatments)

so in other words the guy that recommended surgery is recommending SRT at probably .3 or higher? my advice is to run from this guy and find someone who will treat you NOW. good luck man.

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age: 63
12/09 -- PSA 6.8
G7 -- 3+4 (all 12 cores pos)
HT, BT and IGRT
6/26/18 -- 8-year post treatment PSA .1!
(Post HT PSAs .2, .3, .2, .3, .2, .1, .2, .2, .1, .1, .1, .1,.1)

/instagram.com/edraderphotography/

Thanks everyone for all the insight. Am anxiously awaiting call back from Emory RO.