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Thread: Two Year Reprieve at an end

  1. #1
    Regular User
    Join Date
    Apr 2017
    Posts
    17

    Two Year Reprieve at an end

    Hello friends -

    I came here two years ago in a complete state of panic when my husband was diagnosed with prostate cancer. Here is that original post:

    https://www.cancerforums.net/threads...ghlight=carmel

    You were all very kind to me.

    Since that time my husband has had his prostate removed. One year later he underwent radiation. Now yet another year has passed and his numbers are rising again. He will have a bone scan and CT scan next week. Depending on the results or lack of results from those tests, he may have a PET scan next.

    His PSA is currently .75. That's 50% more than a month ago, which was 50% more than a month before that. He has cancer somewhere. We just need to find it.

    I would welcome any suggestions, ideas, experiences, encouragement, or just general kind words.

    Thanks so much.

    Carmel
    My 57-year-old husband was diagnosed with aggressive prostate cancer March 31, 2017
    (Previous biopsy 2015 did not detect cancer)
    3/2017: PSA 21. Fusion biopsy; two ROI, 16 cores; Stage T1, Gleason score 4+5 = 9
    4/2017: Pre-surgical bone scan and CT scan both clear. No evidence of cancer in bones or lymph nodes.
    6/2017: DaVinci robotic prostatectomy; biopsy of lymph nodes and prostate during surgery did not show cancer outside the prostate.
    6/2017: Post-surgery biopsy showed cancer in base of seminal vesicles, but contained with clean margins.
    7/2018: PSA levels increased steadily following surgery. Lupron followed by 32 days of radiation on the prostate bed.
    7/2019: PSA levels rising following radiation; after 9 months, PSA is .75 with a doubling time of 3.5 months.
    7/2019: CAT scan and bone do not show location of cancer. PET scan recommended.

  2. #2
    My only suggestion is an Axumin PET and if that is negative try the Gallium-68 PSMA-11 PET scan under clinical trial at University of Michigan.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    3/6/19. Pathology - Grade Group 4 with Intraductal Carcinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 03 (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    3 Part Modality Treatment

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  3. #3
    @Carmel... I'm so sorry you've found yourself back in the group looking for more answers. But good news, you're in the right place. These FB and Fs are amazing and filled with so much knowledge. Keep positive and keep praying. I also think it would be good to update your sig. It doesn't show much about margins and complete path without referring to other post. Will be easier for fb to review. I saw you mentioned he had a second treatment, give more details about psa as well. I'm sure they will lead you with info to help. Be blessed.
    Last edited by Honeybun078; 09-07-2019 at 03:06 PM.

  4. #4
    I'm sorry I can't be of help but I will say I'm sorry you're still dealing with this and I'll say some prayers for both of you.

  5. #5
    What the doctors are most likely to do at this point in time is to suggest Androgen Deprivation Therapy. Suppressing testosterone has been shown to be very effective at arresting the progress of Prostate Cancer- sometimes for many years.

    There are also newer chemo and immunotherapy treatments that are being prescribed for prostate cancer.

    Its certainly a good sign that the cancer hasn't spread to the bones.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  6. #6
    Regular User
    Join Date
    Sep 2017
    Posts
    31
    Carmel, from one wife to another I understand your fear and concerns. Although I donít have any suggestions or experiences I did want to offer you words of encouragement. Take one day at a time. I try to focus on all the progress thatís been made on prostate cancer. Keeping you both in my prayers.
    Age 64 brother passed from PC age 57
    PSA 4
    12 core BX Oct 24, 2018
    3 cores positive PC rt lateral base
    Gleason 3+3, 3+4, 4+4
    Bone scan negative
    CT negative
    RALP Surgery March 9, 2018
    T Stage: T2c
    Nerve sparing both sides
    Lymph nodes clear
    Margins clear

  7. #7
    Hi Carmel! Had hoped that you were returning to The Forum with good news. Sorry that you and your husband are experiencing new developments. Keep optimistic that there will be a quick way out of this.

    I agree with Duck2's suggestion for getting one of the new PET/CT Scans vs a standard bone scan which will likely not detect PCa at a PSA level = 0.75. Now is the time to pinpoint identify the site(s) of recurrence.

    A couple of questions:

    - Are you currently in the care of a Medical Oncologist (MO) who specializes in treating PCa?

    - How many lymph nodes were removed during surgery? PCa can "hide" in lymph nodes only to emerge at a distant point in time.

    - Did the Pathologist find anything suspicious with the rectal tissue removed during surgery?

    There are many ADT drugs that can put a stop to his rising PSA. And there are newer ADT drugs that will work after others stop working.

    Both the URO Surgeon's and Radiation Oncologist's jobs are over. If not already in the care of an expert MO, now is the time to do so.

    Good luck quickly getting the brakes on his rising PSA and getting the site(s) of recurrence identified and eradicated.

    As always, we are here every step of The Journey!

    MF
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  8. #8
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,373
    Carmel....please post what your husbands radiation treatment consisted of, the PSA readings since radiation was completed.

    Knowing how much radiation he received, and how many sessions he endured, will help us give you more informed advise. The PSA's since he finished radiation are important for us to understand the pattern of the increases.

    He does need an experienced medical oncologist going forward, to help navigate the multitude of options at his disposal. We are here to help, also. Keep the faith!
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  9. #9
    Regular User
    Join Date
    Apr 2017
    Posts
    17
    Hello all -

    Thanks again for your kindness. My husband has chosen to keep his cancer diagnosis private in our real lives, so I have no one with whom to discuss my fears. You are filling that role for me.

    My husband had about 32 sessions of radiation. I will ask him for the pathology report and details on his PSA numbers through surgery and radiation and the year since.

    He is now under the care of a medical oncologist. The oncologist is the one who ordered the CAT scan and bone scan. Our insurance will only cover a PET scan if the other scans have already been given. The oncologist seems sure that the bone scan and CAT scan won't give us the information we need, and that my husband will need the PET scan to locate the cancer.

    I have not heard of more than one type of PET scan. You've given me information to research. Thank you. I want to be prepared with questions when we meet with the oncologist on Tuesday.

    My husband dreads the hormone blocking drugs (Lupron). He took Lupron for six weeks before radiation last summer. Lupron gave him hot flashes, left him exhausted all the time, and completely killed his sex drive. He has worked very had to regain and maintain his sexual function since surgery (though certainly with adjustments). He doesn't like to think of giving it up. I just want him here, with or without.

    Carmel
    My 57-year-old husband was diagnosed with aggressive prostate cancer March 31, 2017
    (Previous biopsy 2015 did not detect cancer)
    3/2017: PSA 21. Fusion biopsy; two ROI, 16 cores; Stage T1, Gleason score 4+5 = 9
    4/2017: Pre-surgical bone scan and CT scan both clear. No evidence of cancer in bones or lymph nodes.
    6/2017: DaVinci robotic prostatectomy; biopsy of lymph nodes and prostate during surgery did not show cancer outside the prostate.
    6/2017: Post-surgery biopsy showed cancer in base of seminal vesicles, but contained with clean margins.
    7/2018: PSA levels increased steadily following surgery. Lupron followed by 32 days of radiation on the prostate bed.
    7/2019: PSA levels rising following radiation; after 9 months, PSA is .75 with a doubling time of 3.5 months.
    7/2019: CAT scan and bone do not show location of cancer. PET scan recommended.

  10. #10
    Carmel..... Trust God.. Trust his promise.. Your husband will be here with you. Research to know as. Ich as you can, find yourself the medical team that has the expertise to maintain this disease. I pray the Pet scan finds the cancer and its treated or managed for years.. Your FB and FS are here for you. I am the wife and advocate for my husband here, so I definitely understand the emotions. Stay a deep breathe, say a prayer and know that this too shall pass... We are all here for you.

 

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