PSA After

In the context of prostate cancer, a "relapse" is certainly cause for concern; however, it does not the same risk to a person's life as what is typically associated with most other forms of cancer. In fact, some prostate cancer relapses are so slow-growing that no further intervention is required. (Although, it is important to keep in mind that some prostate cancer relapses do represent life-threatening situations that may require careful attention.)
In this video, PCRI's Alex and Medical Oncologist Mark Scholz, MD, survey "biochemical relapse" or a rising PSA after surgery or radiation for prostate cancer, the factors that help physicians determine the risk of a relapse, and the best courses of action depending on the level of risk. Moreover, Dr. Scholz emphasizes the recent advent of commercialized PSMA PET scans and their potential to change/specify treatments and treatment intensity in relapse settings to achieve higher cure rates and/or lower side effect rates.
0:07 How is PSA used to monitor prostate cancer patients after surgery?
1:30 Regarding PSA and monitoring after surgery, what sort of timelines do you expect to see? That is, when do you expect the PSA to reach its lowest point (aka PSA nadir)?
2:57 What does a rising PSA mean 60 days or more out from surgery?
5:58 Which factors determine the urgency with which men should have salvage radiation if their PSA begins rising after surgery?
8:30 Does insurance typically cover PSMA PET scans for men in the relapse setting?
8:52 What is the procedure for patients who have a rising PSA, but their cancer does not show up on a PSMA PET scan? Around 10% of prostate cancers do not produce the PSMA molecule that the PET scan uses to detect cancers with unprecedented specificity and sensitivity.
10:01 What should a person's first steps be if they are diagnosed with a rising PSA after surgery?
10:43 What is the meaning of "biochemical recurrence?"
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[@photosbyjose]

I got my surgery March 11,2023 and I got my first post psa test and it was 0.01 undetectable. And follow up every 3 months for a year. And last psa was 0.00 hopefully it will stay that way for the rest of my life.

[@blackknight125]

Mines was done June 14th over a year ago so far everything is good however on pins and Needles I have very aggressive cancer Praying it stayed that way.

[@GogsGagnon]

Excellent video and much appreciated. My PSA was undetectable at

[@schmingusss]

Did you have to deal with sexual disfunction and incontinence?

[@1958zed]

Great video. It mirrored my exact predicament. Surgery in January 2011; undetectable PSA until September 2015 (0.05 ng/mL); PSA grew slowly, reaching 0.21 in July 2021. I really wanted to know where the cancer was before salvage radiation therapy, so I had PSMA PET scan November 2021 with my PSA at 0.23. It was inconclusive, not showing any hot spots. PSA rate of increase accelerated to 0.36 by April 2022 so my team and I agreed to move forward with SRT with concurrent ADT. SRT ended August 2022, and PSA May 2023 was 0.11. Will retest in November to see if the effects of SRT continue to kick in and decrease it further. Being in that "no man's land" between a rising PSA and the inability of a PSMA PET scan to detect locations at my PSA level put a lot of stress on the decision-making process.

[@robertmonroe3678]

Seems like you and your team followed a very logical route in addressing your reoccurrence. And your concerns regarding salvage radiation without detecting cancer location are points well taken. Is there a way to determine whether your PSA decrease from .36 to .11 was due to ADT or SRT? I’m guessing if your PSA moves up you might conclude the SRT was mis-targeted and you might continue with PSMA scans. And if PSA continues decline that means you successfully hit a critical mass of cancerous cells with the SRT?

[@1958zed]

@@robertmonroe3678 Hi Robert, Yes, when you screw with two variables simultaneously, it's difficult to asses which is having the impact. For more context, we ended the SRT on 27 August and I had a PSA test on 13 Sept and again on 1 November, and both came in at 0.05 ng/mL. Because it was so soon after the radiation ended and because the ADT dose was still active, we attributed those PSA values to the ADT. I had another PSA test on 7 March and that came back at 0.13. We assumed the six month dose of ADT had worn off by that point, and this was more indicative of the SRT's effect. The next PSA on 9 May was 0.11 which has left us cautiously optimistic that the SRT is working. (My radiation oncologist said it could take 18-24 months for the SRT to fully do its thing.) I'm hoping that the November PSA test will have one more data point less than 0.11 ng/mL to help establish a downward trend. Time will tell.

[@jeffdavis4898]

​@1958zed that's me now psa steady at .04 for 8.5 yrs now. 08, so did psma...result negative, so closely monitoring psa to see where it goes.

[@janmariablackwell8138]

My husband had an operation by a top man in London ( professor Eden). Although his cancer was advanced, he didn't need chemo, hormones or radiation. Five years on and his PSA has been slowly climbing. Its now 7.5. The problem is, we have moved a long way from London and when my husband recently saw his GP and explained his history, the GP suggested he should have a feel of his prostate! My husband had to explain he no longer had a prostate, so the GP asked him how his ejaculate is!! Isn't it time that more general practice practitions learnt more about post operative prostate cancer patients?

[@schmingusss]

What a horrible GP.

[@henryrich46]

I had surgery nearly a year ago and since then have had PSA scores of .075, .047 and .054. As the prostate was removed with clear margins, I asked my urologist where this residual PSA could be coming from. He said he didn't know but said there are sometimes bits of prostate tissue outside the prostate, for example in the bladder, that have been there since embryological development. Has anyone else come across this?

[@maxthemagition]

In August 2007 I got a private health check and my PSA was 5.64. Early this year 2023 I went ot the doctor for frequent visits to the toilet during the night and the doctor took a blood sample for a PSA test which was foun to be over 10 at 11.5. So my PSA went from 5.64 to 11.5 over a period of 15 to 16 years during which I have been very healthy other than the frequent visits to the toilet during the night for a wee. Anyway this was followed up from early this year ...scans, biopsy etc to find that I have Gleeson 4/3 and now I am on Hormone therapy for 6 months during which I will receive radiation therapy over 3 weeks. My testostorone level is going down and I feel aged, body sweats and fatigued. I read that my PSA should come down to near zero after Ratiation Therapy, but if it goes up slightly, I could be back to square one as it indictes that the cancer could still be present. Is there no escape for this nightmare?

[@tnvol5331]

i am told a PSA after surgery of .01 is not considered undetectable

[@tammymaxwell2470]

What about a psa 2 years after RP surgery of 0.03? It's been at 0.01......but is going up. Stage 3 highly aggressive,high risk Gleason score was 9 all before RP surgery...... and nothing was spared.

[@warrenmaralit2461]

Which is more accurate, G68 or F18 PSMA

[@jim7060]

Hi love your shows... My PSA is 36.7 I just had a PMSA PET SCAN and no spread was found.☝️🙏☝️ I've opted to have my prostate removed in about 4 to 6 weeks. Realistically what are my chances of having hidden cancer anywhere else. I'm 64 years old.

[@jeffgarner3178]

I had a simple prostectomy mine was .4 3 months after

[@schmingusss]

Do you feel it was worth it in retrospect?

[@jeffgarner3178]

@@schmingusss well yes as I had a very large prostate 151CC I think and had to wear a Catheter bag for 2 1/2 months before procedure. I had low grade of Cancer.

[@PatricksNMhomes1]

Why are people getting surgery? Removal of the prostate has irreversible consequences....

[@crankyneanderthal6784]

I was diagnosed with an aggressive prostrate cancer with a PSA of 38 and with 11 cores Gleeson 3+4, 1 core Gleason 4+5 and only one clear core. I also had mets to distant lymph nodes. Both the urologist and oncologist concluded that the best course of action was its removal. I suffer ED as seminal vessels were removed and have to deal with HRT (aka chemical castration). Treatment is brutal but you must makes choices at the drop of a hat.

[@PatricksNMhomes1]

I believe the consensus now among experts is that if it's outside the capsule and no longer contained then removal would affect quality of life greatly. Now they are also saying that if localized it shouldn't be removed either because there are too many treatment options for management.

[@robertmonroe3678]

Your latter point is the well-articulated perspective of Dr. Scoltz and some others. At the same time there are equally-respected folks (urologists, radiologists, and oncologists) that may recommend surgery for folks in good health under 65 with Grade Group 2 (3 + 4) believed to be contained within the prostate. And that is why the operation is routinely performed at Sloan Kettering, Mayo, etc.

[@PatricksNMhomes1]

well, hopefully, those other well-respected physicians realize that only 15% of the diagnosed cancers are the ones that need treatment and the other 85% are the ones that need nothing but a healthy diet, exercise, and some well-directed supplements, and watchful waiting. The 10-year survival rate for PC is 98% whether treated or not treated. Active monitoring of prostate cancer has the same high survival rates after 15 years as radiotherapy or surgery. These routine conventional operations need more scrutiny and patients need to consult with multiple UROs, and always get 2nd and 3rd opinions of pathology and 3TMRI reads. @@robertmonroe3678

[@crankyneanderthal6784]

When Dr Schulz mentions the detection rates for PSMA PET scanners when PSA 0.2, detection 20%, PSA 0.5 Detection 50% PSA is 1, Detection is 90% is he referring to standard PSMA PET scanners. There is a new generation of Super sensitive PET scanners such as the Seimens Quandra that is faster, and more sensitive whilst using less radiation dose. My oncologist indicated that standard PET scanners can only detect tumours 2-3 mm in diameter but cannot detect smaller cancer cells. The problem is that you cannot treat what you cannot see. If you can identify more though smaller cancerous cells then the treatment options are more advantageous to those of us with metastasis. The first patient scanned by a Quandra in Melbourne Australia was a PC patient with mets. I am not aware of the outcome of his case. I have indicated to my oncologist that I want be scanned by the Quandra when my PSA begins to dlimb. Has anyone any experience with these new generation PET scanners? Can PCRI comment? Am I barking up the wrong tree? www.9news.com.au/national/body-scanner-to-change-the-way-cancer-brain-and-heart-disease-is-detected/e9eb5a61-8e27-4518-accf-797426f372c2

[@robertmonroe3678]

I wonder if it is a chemical agent (Pylarify, etc) issue or a PET issue that prevents the PSMA PET CT Scan from detecting at 'lower" PSA levels (0.2, for example) . If the chemical agent simply doesn't 'find' the Prostate Cancer's PSMA at lower levels than this particular issue is not a PET issue (and we need a better chemical agent). But if the chemical agent it does 'find' the Prostate Cancer's PSMA at lower levels it may be a PET issue. In any case, Australia has been cutting edge with PSMA PET CT so perhaps this new scanner is part of that process.