Great video, but about 2 years too late for me. I had a radical prostatectomy in January 2011 and my PSA was undetectable for almost 5 years until September 2015 when it came in at 0.05 ng/mL. It took nearly 6 years for my PSA to get to 0.21 in July 2021 (with such a long doubling time, my medical team and I decided to postpone salvage radiation therapy (SRT) and just monitor my PSA. In October 2021, my PSA hit 0.22 and I had scheduled a PSMA PET Scan at UCLA in November 2021. The results of the scan were inconclusive and of no use to my radiation oncologist in terms of deciding where to zap. BTW, I think it's quite important for you and Dr. Scholz to highlight the probability of a PSMA PET scan actually picking up cancer at various PSA levels. While it's certainly true that PSMA PETs can see cancer with PSAs as low as 0.2, from my research, that happens only 30% to 40% of the time. PSMA PETs seem to pick up cancer about 90% of the time when your PSA is at 1.0 or higher. In any case, my PSA took off like a rocket (slight exaggeration) and hit 0.33 in March 2022 and 0.36 a month later in April 2022. I started a six-month does of Eligard in May 2022 and had 35 SRT sessions July-August 2022. In November 2022, my PSA dropped to 0.05 after the SRT with concurrent ADT (most likely all from the Eligard). In March 2023, my PSA was 0.13, well below the starting point a year earlier, and in May 2023 it dropped even further to 0.11. I was hopeful that the SRT was kicking in and driving the cancer / PSA down. However, that wasn't the case. In November 2023, my PSA nearly doubled from 0.11 to 0.21, which was quite shocking. I go for a confirmation PSA the first week of December. For me, the KEY TAKEAWAY from this video is that I should have had a second PSMA PET scan when my PSA was at the 0.36 mark. It may have given the radiation oncologist a better idea for where the cancer is, and perhaps we could have avoided zapping the prostate bed. So far 16 months after the radiation, my incontinence hasn't worsened, but my ED has. Fortunately, there have been no bowel control issues as of yet. One of the reasons I delayed treatment for so long is that I really wanted to know where the cancer was before zapping. But the rapid increase in my PSA from 0.22 to 0.36 in six months became the controlling factor that made me decide to go ahead without knowing exactly where it was. It's all a trade-off with each of our own individual comfort levels / risk tolerance levels. Again, thank you for posting.
You should try "hyperthermia" an high doses of vitamin C IV-s. There treatments have reduced PSA from 14 to 3.4. Please research it an do it. cancer cells die from high treat treatments.
thanks, ED- i'm in the same boat. watching .1-.2 level for 6 months. already had prostate zapped. feel good except for the covid, been burning candle both ends-getting ready for JUDGEMENT DAY someday. go to church on sunday and praise the one and only GOD- JESUS CHRIST!!
Your presentations are incredibly useful and informative. You have covered many of the aspects of the treatment I have received enabling me to make informed decisions in conjunction with my medical team. I thank you very much indeed.
Hi Dr. Scholtz / Alex, thanks for the work you do in informing sufferers of the various levels and risks of Prostate Cancer. I like many others am confused about my ongoing treatment, I will list my position and ask you to comment or advise. I am in Australia Perth WA. I am 68 years of age, in good overall health. I had a PSA OF 7.5 for about two years and was advised by my Urologist to undertake a radical Prostatectomy which I had done in February this year 2023. I also had PSMA PET SCAN at that time which showed a small hot spot on the Prostate only. The first follow up PSA test was first 0.0 then 0.01, 0.02, 0.03. The Urologist now has referred me to a Radiologist based on the rising PSA. a suggested seven week treatment awaits. I have requested further blood tests for December and January and suggested to them I may undergo treatment January or February. My questions are the obvious ones the reading is very low but I understand increasing, also a further PSMA PET may not detect anything at such a low level. What other testing could be done and at what point do I go ahead and undertake the treatment? With the continued side effects and the possibility of further worsening of those side effects Incontinence and erectile dysfunction is it wise to proceed at such speed? Not to mention the possible damage to other near by organs in the area where the Prostate was. The proposed treatment is a no cost item to me as our health system takes care of it so no out of pocket costs at all to me. But I feel just a little like a target to add to the bottom line of the medical practitioner's billings. If you would care to comment or email me directly I would greatly appreciate a second opinion. Thanks again. Regards Kel😊😊
ED, USA, been longer trip than you. my PSA easing up after all the above. waiting on 2-3 to PSMA. its a long road. my guess is cancer was outside the prostate after surgery = radiation. so how does PSA test measure without a prostate?????? never had symptom except couldnt hold my piss in cold weather. getting over covid which is rampant again in TENN. if the chinese/ our CIA had compliticity, then to HELL with them.
Another great video. Just finished my radiation therapy. My PSA now is 0.058 and my testosterone level is less that 2.5. Now in active surveillance. Thank you.
Here's a general question I'd like to see covered in a future video. To what extent have most (or perhaps all) prior studies been rendered irrelevant by the advent of post-treatment monitoring by PSMA-PET scans? It seems like all of the previous survival rates and other endpoints were derived from doctors who were basing post-treatment analysis on inaccurate and unreliable PSA levels and bone scans.
Thank you for these videos. Someone very close to me has undergone Chemo for Metastatica Prostate cancer with a PSA level of 130. Yes, 130. It is down below 1 at this time. He had a PETPSMA scan that showed the area of spread. Now due to (PSA > 2) apparently the PETPSMA scan is not covered by insurance. He had a CT and Bone scan/waiting for results. We will check into these other mentioned tests. Again thank you.
Firstly, thank you to PCRI for this highly educational (and reassuring and calming) series. Secondly, pathology may be a consideration as radiation to the prostate bed/lymph nodes (given rising PSA without PSMA avidity) for those with positive margin(s) would seem reasonable to this non-doctor.
האנגלית שלי גרועה אבל רוצה להגיד בשם משפחתי תודה ענקית . התרומה שלכם אדירה עוזרת מאוד השאלות נשאלות בחכמה רבה , התשובות חדשניות בגובה העיניים בהירות ביותר הגיוניות ולא מסתירות שטחים אפורים או טעוני מחקר. תודה למראינת תודה לרופא ❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤
Thank you. My PSA is going up 2 1/2 years after surgery. .017, 3 months later .038 to now .174, which is 4 time increase in 3 months. Dr. Apt. in 4 days, not waiting another 3 months going back to my surgeon.
Huge fan of PCRI and an early subscriber to the channel. I’m hoping for a future video for the millions of us, including both of my brothers, in an anxiety laden “watchful waiting” protocol. I lost my paternal grandfather to prostate cancer and my maternal first cousin is fighting for his life. Three years ago at age 64 my PSA rose from 2.2 to 5.6 in a 12 month period. I underwent 15 core random biopsy which was negative and have been in the HMO playbook of semi-annual PSA tests (results from 4.7 to 5.7) ever since. My PSAD is .08 and my BRCA1/2 showed no negative variants. I’ve finally convinced my urologist to schedule an MRI after initially being told it wasn’t the HMO’s policy to do an MRI before a random biopsy. I feel like I’m receiving a 20 to 30 year old approach after watching your channel. What is your advice for those of us in a similar situation who just want to know if we have cancer or not?
I'm the same age as you w/ similar PSA readings over 2 years. My "forward thinking" Primary Doc, scheduled a 3T MRI. (MUST be a 3T.....the "Latest-n-Greatest" in imaging technology). Only After the 3T MRI showed a lesion, did I go for the 18 needle Biopsy. They did find some cancer and gave me a Gleason Score of 3+4=7. Upon advice from this channel I resubmitted the biopsy slides to John Hopkins. They came back w/ a 3+3=6 Gleason Score. Went for a "tie-breaker" at the Proton Beam institute in Jacksonville, FL. They side w/ John Hopkins....3+3. [I'll go for Proton Beam, as that seems to offer the least impact on my quality of life, when the time is right.....].
@@peterb2346- thanks for sharing, Peter. Valuable lesson in self advocacy there. Happy to hear you were downgraded to 3+3. I’ll post my results here after my traditional MRI.
Hi there, just need a bit of advice, diagnosed with PC 2 years ago age 70, 8:11 gleeson score 4 ×4 psa 7 32 cc prostate, after having 18 months of hormone treatment and 20 treatments of radiotherapy psa Nadir of 0.01. My testosterone had recovered to 17.5 but my psa has gone up to 0.34 after my last 6 monthly test my testosterone is now 20.5 but my psa is 0.44 my nurse has told me this is expected now my testosterone has recovered to normal is this correct. Thank you.
I find your videos extremely helpful. I wonder if you might be able to address my scenario which I think hasn’t been addressed. I had a rising PSA, had biopsy confirming 3+4 and some 4+3. The PSMA study showed I had lymph nodes near the prostate which were at a higher SUV level and some other nodes abdominal and one in my neck that was lower around 10 SUV. I have what was termed low volume metastatic disease. I elected to have surgery which revealed a small area of the gland showing a Gleason 5 and after taking out 10 lymph nodes in the side of the gland that had cancer only one was cancer in pathology. I started lupron and abiraterone. At 6 weeks post op I should have a PSA and am wondering what I should do if it’s undetectable since I am on ADT. Should I stop ADT and see if it rises and then have a PSMA scan and consider RT or chemotherapy? PSMA has turned upside down the management of PrCA and some med Inca told me I should not have had surgery and just eat ADT. Trouble with that approach according to Dr Kwon is ADT is likely to fail after 1-2 years and then where am I. So I decided to have surgery and want to do the best I can to manage distant disease and not wait for ADT to fail. I think there are many patients who formerly had Mets but were never seen by traditional nuclear medicine scans so post surgery, after thinking the disease was localized to the gland then has rising PSA.
Hello, Just found your channel. I'm 61 years old. Was diagnosed in Oct of 2008 at 46 yrs old. Had my prostate removed. PSA started rising in 2011. Had 16 weeks of radiation in the pelvic area. Continued PSA checks. Started rising again in 2015. It was 0.05. It was recommended to monitor. In 2021 it got to 0.740. Was introduced to a PSMA scan. Since then I've had 3 PSMA scans, nothing detectable. My last scan was 2 months ago.My PSA is now 3.23. My oncologist is still recommending to monitor.I have an appointment in May to recheck PSA. I must be in 10% group that reads undetectable. I have an appointment with a radiation oncologist. Same one that did my treatment in 2011. Do you have any words of wisdom?
Had an rp age53 now 56 and i was that man that had a pet scan and it did not work for me my psa had got back to 0.52 in the end they went for it gave me 20 days of radiation and 6months of hormone treatment psa is now 0.03 and so far so good time will tell.
My radiation oncologist wanted to start me on six weeks of radiation and then hormone therapy. My PSA after surgery now two years after surgery is .04. During the last two years it has gone from .01 to .04. Now the last two PSA test were .043 months apart, I’m not so sure about radiation right now and therapy
I am undergoing radiation treatment combined with Eligard shots for recurrence after robotic prostatectomy in 2019. At that time my Gleason was 4+3. PSMA PET revealed spread to 5 pelvic lymph nodes 2 on left, 3 on right. Sizes are 4 mm to 7 mm. What should expected nadir be, and what PSA level is considered undetectable? Perhaps this could be subject matter for an upcoming video. Thank you so very, very much for these videos and for what you do !
Great. In my own case MRI(T3) indicates no tumor or lesion exists after 2 years harmonal therapy but PSA rises from zero to 11.5 when stopped ADT and PSA comes to 11.5 from zero in 6 months time. Initially prostate cancer has been diagnosed in my right side stage intermediary. What do you suggest how long ADT be continued? And when there is no more tumor showing, do I still need radiation?
NCCN guidelines recommend salvage radiation once the PSA gets above 0.1 ng/mL. I recommend following it regardless of a negative PSMA PET scan. Earlier is better. Don't wait until 0.2 ng/mL.
Why? Salvage radiation blasts a whole "suspected" area of where the cancer cells might be. What if you waited until .2 and PET showed a lesion outside of the salvage area radiation blast? You will have zapped areas that didn't need the radiation, and not zapped the area that needed it. It may indeed be best to wait until .2.
@@deemika There is truth to what you write if one would truly know that the cancer has already gone metastatic. Otherwise, if the cancer is still localized to the pelvis, then the research shows that for salvage radiation, the lower the PSA the better the outcomes. It is what it is. But yes, in theory if you knew you had a distant metastasis already, salvage RT would make no sense as you are already doomed. This is exactly the case for most people who have a recurrence following salvage RT. However, even if the cancer is indeed localized, there is no guarantee that salvage RT will work, because even if just a few cancer cells survive (whether they were missed or they repair themselves) you would eventually experience a recurrence.
ED, been there done that! I suggest the hellish surgery was wasted since I had 33 rad. treatments in prost. bed. now wondering if cancer was outside BED since psa easing up??? or was the cancer spread thru the hell-surgery?
@@patriciareynolds2729 Well if even a few cells are missed....Keep in mind it is pretty common for a recurrence to occur after surgery. It happens about 40% of the time. And I don't know your pathology so you might have had a high risk cancer which makes recurrence even more likely. I hope you remain in remission after salvage RT.
@@patriciareynolds2729 Get a copy of your Operative Report (by the surgeon) AND a copy of the Pathology Report done on the tissue/prostate removed during your surgery. It can be very revealing.
Have a follow up with Dr. Scholz already scheduled about this very scenario - PSA had been increasing over last several years at rate of 0.02 every three months after NSRP 12 years prior, DT over 24 months, now PSA went from 0.80 to 1.45 in six months. PET-PSMA Pylarify shows nothing (3rd one.). So confusing. Thank you for this video. Can’t find links - help with that?
I have a question about the interpretation of a PSMA PET scan after surgery as the PSA is rising and when no cancer is identified. When we talk about getting a second opinion, is it sometimes worthwhile to get a second interpretation of a scan? I assume that some radiologists have more experience in identifying recurrent prostate cancer. How would you go about requesting another specialist to review the interpretation of the scan. I really appreciate the videos and your informative format. Great topics.
How do you deal with a patient that has had prostate surgery and 3 months later the PSA was rising again and then they had 38 radiation treatments along with hormone therapy then a couple of years later their PSA started rising again to .3? Gleason was 5.6 Positive margins, Gleason 9 downgraded to 4+3 post surgery but margins was grade 4? patient is 68 years old and in great health?
I've heard that Covid-19 can cause an increase in PSA levels for those men with BPH. Can Covid also cause a PSA increase in those of us with prostatectomies?
Great video, but about 2 years too late for me.
I had a radical prostatectomy in January 2011 and my PSA was undetectable for almost 5 years until September 2015 when it came in at 0.05 ng/mL. It took nearly 6 years for my PSA to get to 0.21 in July 2021 (with such a long doubling time, my medical team and I decided to postpone salvage radiation therapy (SRT) and just monitor my PSA.
In October 2021, my PSA hit 0.22 and I had scheduled a PSMA PET Scan at UCLA in November 2021. The results of the scan were inconclusive and of no use to my radiation oncologist in terms of deciding where to zap.
BTW, I think it's quite important for you and Dr. Scholz to highlight the probability of a PSMA PET scan actually picking up cancer at various PSA levels. While it's certainly true that PSMA PETs can see cancer with PSAs as low as 0.2, from my research, that happens only 30% to 40% of the time. PSMA PETs seem to pick up cancer about 90% of the time when your PSA is at 1.0 or higher.
In any case, my PSA took off like a rocket (slight exaggeration) and hit 0.33 in March 2022 and 0.36 a month later in April 2022.
I started a six-month does of Eligard in May 2022 and had 35 SRT sessions July-August 2022.
In November 2022, my PSA dropped to 0.05 after the SRT with concurrent ADT (most likely all from the Eligard). In March 2023, my PSA was 0.13, well below the starting point a year earlier, and in May 2023 it dropped even further to 0.11. I was hopeful that the SRT was kicking in and driving the cancer / PSA down. However, that wasn't the case.
In November 2023, my PSA nearly doubled from 0.11 to 0.21, which was quite shocking. I go for a confirmation PSA the first week of December.
For me, the KEY TAKEAWAY from this video is that I should have had a second PSMA PET scan when my PSA was at the 0.36 mark. It may have given the radiation oncologist a better idea for where the cancer is, and perhaps we could have avoided zapping the prostate bed. So far 16 months after the radiation, my incontinence hasn't worsened, but my ED has. Fortunately, there have been no bowel control issues as of yet.
One of the reasons I delayed treatment for so long is that I really wanted to know where the cancer was before zapping. But the rapid increase in my PSA from 0.22 to 0.36 in six months became the controlling factor that made me decide to go ahead without knowing exactly where it was. It's all a trade-off with each of our own individual comfort levels / risk tolerance levels.
Again, thank you for posting.
You should try "hyperthermia" an high doses of vitamin C IV-s. There treatments have reduced PSA from 14 to 3.4. Please research it an do it. cancer cells die from high treat treatments.
thanks, ED- i'm in the same boat. watching .1-.2 level for 6 months. already had prostate zapped. feel good except for the covid, been burning candle both ends-getting ready for JUDGEMENT DAY someday. go to church on sunday and praise the one and only GOD- JESUS CHRIST!!
Did you zap the prostate bed and pelvic lymph nodes? Is your plan to get another PSMA if your PSMA goes back to the .36 range?
@@robertmonroe3678 We zapped just the prostate bed, no pelvic lymph nodes. We'll likely do another scan before any ADT begins.
Is 0.08 PSA after radical prostatectomy, too high ?
Thank you for another excellent video. Your videos are a tremendous help to me. I am currently fighting prostate cancer.
Your presentations are incredibly useful and informative. You have covered many of the aspects of the treatment I have received enabling me to make informed decisions in conjunction with my medical team. I thank you very much indeed.
Great questions and better answers. Thanks you'll for all you do stay safe and much love ❤️
Great synthesis and recommendations, especially near the tail end. Thank you, PCRI!
Thank you. Leading-edge prostate cancer information like this is very valuable.
Hi Dr. Scholtz / Alex, thanks for the work you do in informing sufferers of the various levels and risks of Prostate Cancer.
I like many others am confused about my ongoing treatment, I will list my position and ask you to comment or advise.
I am in Australia Perth WA. I am 68 years of age, in good overall health.
I had a PSA OF 7.5 for about two years and was advised by my Urologist to undertake a radical Prostatectomy which I had done in February this year 2023.
I also had PSMA PET SCAN at that time which showed a small hot spot on the Prostate only.
The first follow up PSA test was first 0.0 then 0.01, 0.02, 0.03.
The Urologist now has referred me to a Radiologist based on the rising PSA. a suggested seven week treatment awaits.
I have requested further blood tests for December and January and suggested to them I may undergo treatment January or February.
My questions are the obvious ones the reading is very low but I understand increasing, also a further PSMA PET may not detect anything at such a low level.
What other testing could be done and at what point do I go ahead and undertake the treatment?
With the continued side effects and the possibility of further worsening of those side effects Incontinence and erectile dysfunction is it wise to proceed at such speed?
Not to mention the possible damage to other near by organs in the area where the Prostate was.
The proposed treatment is a no cost item to me as our health system takes care of it so no out of pocket costs at all to me.
But I feel just a little like a target to add to the bottom line of the medical practitioner's billings.
If you would care to comment or email me directly I would greatly appreciate a second opinion.
Thanks again.
Regards Kel😊😊
ED, USA, been longer trip than you. my PSA easing up after all the above. waiting on 2-3 to PSMA. its a long road. my guess is cancer was outside the prostate after surgery = radiation. so how does PSA test measure without a prostate?????? never had symptom except couldnt hold my piss in cold weather. getting over covid which is rampant again in TENN. if the chinese/ our CIA had compliticity, then to HELL with them.
Another great video. Just finished my radiation therapy. My PSA now is 0.058 and my testosterone level is less that 2.5. Now in active surveillance. Thank you.
Here's a general question I'd like to see covered in a future video. To what extent have most (or perhaps all) prior studies been rendered irrelevant by the advent of post-treatment monitoring by PSMA-PET scans? It seems like all of the previous survival rates and other endpoints were derived from doctors who were basing post-treatment analysis on inaccurate and unreliable PSA levels and bone scans.
I got a PSMA/PET with a PSA
Thank you for these videos. Someone very close to me has undergone Chemo for Metastatica Prostate cancer with a PSA level of 130. Yes, 130. It is down below 1 at this time. He had a PETPSMA scan that showed the area of spread. Now due to (PSA > 2) apparently the PETPSMA scan is not covered by insurance. He had a CT and Bone scan/waiting for results. We will check into these other mentioned tests. Again thank you.
Extremely valuable video, thanks!
Firstly, thank you to PCRI for this highly educational (and reassuring and calming) series.
Secondly, pathology may be a consideration as radiation to the prostate bed/lymph nodes (given rising PSA without PSMA avidity) for those with positive margin(s) would seem reasonable to this non-doctor.
האנגלית שלי גרועה אבל רוצה להגיד בשם משפחתי תודה ענקית . התרומה שלכם אדירה עוזרת מאוד השאלות נשאלות בחכמה רבה , התשובות חדשניות בגובה העיניים בהירות ביותר הגיוניות ולא מסתירות שטחים אפורים או טעוני מחקר. תודה למראינת תודה לרופא ❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤
Thank you. My PSA is going up 2 1/2 years after surgery. .017, 3 months later .038 to now .174, which is 4 time increase in 3 months. Dr. Apt. in 4 days, not waiting another 3 months going back to my surgeon.
Huge fan of PCRI and an early subscriber to the channel. I’m hoping for a future video for the millions of us, including both of my brothers, in an anxiety laden “watchful waiting” protocol. I lost my paternal grandfather to prostate cancer and my maternal first cousin is fighting for his life. Three years ago at age 64 my PSA rose from 2.2 to 5.6 in a 12 month period. I underwent 15 core random biopsy which was negative and have been in the HMO playbook of semi-annual PSA tests (results from 4.7 to 5.7) ever since. My PSAD is .08 and my BRCA1/2 showed no negative variants. I’ve finally convinced my urologist to schedule an MRI after initially being told it wasn’t the HMO’s policy to do an MRI before a random biopsy. I feel like I’m receiving a 20 to 30 year old approach after watching your channel. What is your advice for those of us in a similar situation who just want to know if we have cancer or not?
I'm the same age as you w/ similar PSA readings over 2 years. My "forward thinking" Primary Doc, scheduled a 3T MRI. (MUST be a 3T.....the "Latest-n-Greatest" in imaging technology). Only After the 3T MRI showed a lesion, did I go for the 18 needle Biopsy. They did find some cancer and gave me a Gleason Score of 3+4=7. Upon advice from this channel I resubmitted the biopsy slides to John Hopkins. They came back w/ a 3+3=6 Gleason Score. Went for a "tie-breaker" at the Proton Beam institute in Jacksonville, FL. They side w/ John Hopkins....3+3. [I'll go for Proton Beam, as that seems to offer the least impact on my quality of life, when the time is right.....].
@@peterb2346- thanks for sharing, Peter. Valuable lesson in self advocacy there. Happy to hear you were downgraded to 3+3. I’ll post my results here after my traditional MRI.
Th and you for the helpful content
Hi there, just need a bit of advice, diagnosed with PC 2 years ago age 70, 8:11 gleeson score 4 ×4 psa 7 32 cc prostate, after having 18 months of hormone treatment and 20 treatments of radiotherapy psa Nadir of 0.01.
My testosterone had recovered to 17.5 but my psa has gone up to 0.34 after my last 6 monthly test my testosterone is now 20.5 but my psa is 0.44 my nurse has told me this is expected now my testosterone has recovered to normal is this correct. Thank you.
I find your videos extremely helpful. I wonder if you might be able to address my scenario which I think hasn’t been addressed.
I had a rising PSA, had biopsy confirming 3+4 and some 4+3. The PSMA study showed I had lymph nodes near the prostate which were at a higher SUV level and some other nodes abdominal and one in my neck that was lower around 10 SUV. I have what was termed low volume metastatic disease. I elected to have surgery which revealed a small area of the gland showing a Gleason 5 and after taking out 10 lymph nodes in the side of the gland that had cancer only one was cancer in pathology. I started lupron and abiraterone. At 6 weeks post op I should have a PSA and am wondering what I should do if it’s undetectable since I am on ADT. Should I stop ADT and see if it rises and then have a PSMA scan and consider RT or chemotherapy?
PSMA has turned upside down the management of PrCA and some med Inca told me I should not have had surgery and just eat ADT. Trouble with that approach according to Dr Kwon is ADT is likely to fail after 1-2 years and then where am I. So I decided to have surgery and want to do the best I can to manage distant disease and not wait for ADT to fail.
I think there are many patients who formerly had Mets but were never seen by traditional nuclear medicine scans so post surgery, after thinking the disease was localized to the gland then has rising PSA.
Hello, Just found your channel. I'm 61 years old. Was diagnosed in Oct of 2008 at 46 yrs old. Had my prostate removed. PSA started rising in 2011. Had 16 weeks of radiation in the pelvic area. Continued PSA checks. Started rising again in 2015. It was 0.05. It was recommended to monitor. In 2021 it got to 0.740. Was introduced to a PSMA scan. Since then I've had 3 PSMA scans, nothing detectable. My last scan was 2 months ago.My PSA is now 3.23. My oncologist is still recommending to monitor.I have an appointment in May to recheck PSA. I must be in 10% group that reads undetectable. I have an appointment with a radiation oncologist. Same one that did my treatment in 2011. Do you have any words of wisdom?
Had an rp age53 now 56 and i was that man that had a pet scan and it did not work for me my psa had got back to 0.52 in the end they went for it gave me 20 days of radiation and 6months of hormone treatment psa is now 0.03 and so far so good time will tell.
My radiation oncologist wanted to start me on six weeks of radiation and then hormone therapy. My PSA after surgery now two years after surgery is .04. During the last two years it has gone from .01 to .04. Now the last two PSA test were .043 months apart, I’m not so sure about radiation right now and therapy
I am undergoing radiation treatment combined with Eligard shots for recurrence after robotic prostatectomy in 2019. At that time my Gleason was 4+3. PSMA PET revealed spread to 5 pelvic lymph nodes 2 on left, 3 on right. Sizes are 4 mm to 7 mm. What should expected nadir be, and what PSA level is considered undetectable? Perhaps this could be subject matter for an upcoming video.
Thank you so very, very much for these videos and for what you do !
I was told by a cancer center doctor that an undetectable PSA is .03 or less.
Thank you much and be well!
Thank you
Great. In my own case MRI(T3) indicates no tumor or lesion exists after 2 years harmonal therapy but PSA rises from zero to 11.5 when stopped ADT and PSA comes to 11.5 from zero in 6 months time.
Initially prostate cancer has been diagnosed in my right side stage intermediary.
What do you suggest how long ADT be continued? And when there is no more tumor showing, do I still need radiation?
PSA 0.4 one day 0.3 the next day after a repeat PSA had robotic prostectomy 1 year ago Greyson score 8 need advise
Thank your for sharing. Had Surgery 11 1/2 months ago.. my first 2 psa were 0.1, now it rose to 0.4. Should I be concerned?
NCCN guidelines recommend salvage radiation once the PSA gets above 0.1 ng/mL. I recommend following it regardless of a negative PSMA PET scan. Earlier is better. Don't wait until 0.2 ng/mL.
Why? Salvage radiation blasts a whole "suspected" area of where the cancer cells might be. What if you waited until .2 and PET showed a lesion outside of the salvage area radiation blast? You will have zapped areas that didn't need the radiation, and not zapped the area that needed it. It may indeed be best to wait until .2.
@@deemika There is truth to what you write if one would truly know that the cancer has already gone metastatic. Otherwise, if the cancer is still localized to the pelvis, then the research shows that for salvage radiation, the lower the PSA the better the outcomes. It is what it is. But yes, in theory if you knew you had a distant metastasis already, salvage RT would make no sense as you are already doomed. This is exactly the case for most people who have a recurrence following salvage RT. However, even if the cancer is indeed localized, there is no guarantee that salvage RT will work, because even if just a few cancer cells survive (whether they were missed or they repair themselves) you would eventually experience a recurrence.
ED, been there done that! I suggest the hellish surgery was wasted since I had 33 rad. treatments in prost. bed. now wondering if cancer was outside BED since psa easing up??? or was the cancer spread thru the hell-surgery?
@@patriciareynolds2729 Well if even a few cells are missed....Keep in mind it is pretty common for a recurrence to occur after surgery. It happens about 40% of the time. And I don't know your pathology so you might have had a high risk cancer which makes recurrence even more likely. I hope you remain in remission after salvage RT.
@@patriciareynolds2729 Get a copy of your Operative Report (by the surgeon) AND a copy of the Pathology Report done on the tissue/prostate removed during your surgery. It can be very revealing.
Have a follow up with Dr. Scholz already scheduled about this very scenario - PSA had been increasing over last several years at rate of 0.02 every three months after NSRP 12 years prior, DT over 24 months, now PSA went from 0.80 to 1.45 in six months. PET-PSMA Pylarify shows nothing (3rd one.). So confusing. Thank you for this video. Can’t find links - help with that?
PSA
dear Alex
3 months post radical prostatectomy my pas is 0.01
after 6 months psa is 0.02
is it ok with this level
my regards
I have a question about the interpretation of a PSMA PET scan after surgery as the PSA is rising and when no cancer is identified. When we talk about getting a second opinion, is it sometimes worthwhile to get a second interpretation of a scan? I assume that some radiologists have more experience in identifying recurrent prostate cancer. How would you go about requesting another specialist to review the interpretation of the scan.
I really appreciate the videos and your informative format. Great topics.
How do you deal with a patient that has had prostate surgery and 3 months later the PSA was rising again and then they had 38 radiation treatments along with hormone therapy then a couple of years later their PSA started rising again to .3? Gleason was 5.6 Positive margins, Gleason 9 downgraded to 4+3 post surgery but margins was grade 4? patient is 68 years old and in great health?
After radical prostatectomy,PSA is 0.08 is this too high ?
I had taken the prostate cancer surgery .after six week my PSA is 1.0 . Is it I have to go for hormone therapy ? Or I need to go for MRI scan.Thanks
Thank you for this info.
Very useful information. Just curious Alex, what’s your relationship with Dr. Schulz since you both have the same last name?
She is his daughter-in-law :)
I've heard that Covid-19 can cause an increase in PSA levels for those men with BPH. Can Covid also cause a PSA increase in those of us with prostatectomies?
will find out, recovering from hellish covid now. PSA teat i 3 months.