I have been advised to get a ct scan of abdomen and pelvis with and without contrast, along with a full body bone scan prior to my next appointment with my urologist. PSA has been undetectable since completion 9/9/20 of image guided radiation to the prostate bed and lymph nodes with a 6 month Lupron shot 6/25/20. Prostatectomy was done 9/2015 Gleason 7 (3+4) Stage T2c, N0, MX.
My question is this necessary since my PSA has been undetectable since the radiation treatment? Urologist says this is standard of care....
Thank you for any input. I appreciate it.
John
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I just got a call from my urologist office with word from the PA, that since my PSA has been undetectable for almost 4 years post Image guided radiation, I can wait on the Ct scan of abdomen/pelvis as well as the full body bone scan if I want to.
So I have just cancelled both of those appointments.
In your previous reply, what do the abbreviations stand for? I am not familiar with.
Thank you Allen, I will do some research and also follow up with my Dr that did the RP as well as my RO that did the image guided radiation to the prostate bed and lymph nodes.
I was diagnosed with almost the same stats as you I go for CT scan and bone scan every six months since 2018 . I would imagine it's recommended by our doctors to see if any progression has occurred. Never give up Never surrender Leo
That is what they (nurse, PA, and Dr.) are saying.... I just haven't had to do it since radiation was complete, (last 5 years) and want to get some information from this group. I really appreciate your response! Thank you Leo
I’m guessing you might be in Canada? My Psa in undetectable but I still get the tests you mentioned every year. In my case they think/thought I might be a “low secretor”. As I understand it, that’s someone who’s cancer doesn’t produce much Psa. My MO said he didn’t want to “get caught” by not doing it. They didn’t push the issue but I figure they must feel there is value in doing the tests so I went. The results have been as expected. Nothing showing up on the scans.
I just got a call from my urologist office with word from the PA, that since my PSA has been undetectable for almost 4 years post Image guided radiation, I can wait on the Ct scan of abdomen/pelvis as well as the full body bone scan if I want to.
So I have just cancelled both of those appointments.
I am trying to avoid any unnecessary testing that involves nuclear medicine injected in me.
I get what you say about avoiding radiation. I don’t know your age but your photo makes it appear you are a lot younger than me so I understand your concern.
Hi, Lizzysdad, I know what you mean about being a "low secretor". My PSA had always been at .5 or .6 before I had my biopsy. My PSA then rose to .97, and actually went back down to .84, and at one time it went as low as .69, and my 4K Score Test was 8.2%, and I had a PYRADS 3.. Nevertheless, I was concerned so I insisted on a biopsy. It turned out I had G7 (4+3). I am currently on 6-month regiment of Orgovyx and ready to start proton beam radiation therapy in the next week or two. So, don't put all your eggs in a low PSA basket. I would take the more conservative route and follow-up with your scans just to make sure. As one doctor told me, there is such a thing as "stealth PCa' which could end up being deadly.
Hi, Izzysdad, I know what you mean about being a "low secretor". My PSA had always been at .5 or .6 before I had my biopsy. My PSA then rose to .97, and actually went back down to .84, and at one time it went as low as .69, and my 4K Score Test was 8.2%, and I had a PYRADS 3.. Nevertheless, I was concerned so I insisted on a biopsy. It turned out I had G7 (4+3). I am currently on 6-month regiment of Orgovyx and ready to start proton beam radiation therapy in the next week or two. So, don't put all your eggs in a low PSA basket. I would take the more conservative route and follow-up with your scans just to make sure. As one doctor told me, there is such a thing as "stealth PCa' which could end up being deadly.
I learned to not give this beast time and obscurity. IMO, based on my experiences, with similar RP path and Oncotype DX as your's, and also needing salvage RT then ePLND, I support your urologists recommendation for imaging; although I would discuss different types. In fact, I support his being out ahead of common practice. ('SOC' in IMO is a misleading and risky term, especially as services range from barely acceptable to ultimate in care.
Could not determine from your bio and comments what PSA value you are relying on for 'undetectable' - a term I long ago discarded and also see as misleading and even deadly. Prior to my RP I chose to rely on <0.010 as best indicator; my RP nadir was 0.050 - we accepted cancer remained. My salvage RT was done at 0.11, nadir 0.075, missed again. Given that I then had six cancerous pelvic nodes removed by salvage extended pelvic lymph node surgery, at 0.11, there is no doubt remaining cancer is present well below 0.1.
Six years ago my salvage ePLND achieved nadir of <0.010, no ADT. After two years a very slow and stable rise began, been holding 0.03X range for past thirty-five months. Yes, ahead of 'guidelines', I have been doing annual imaging, mpMRI with PSMA, and blood biopsy. Sometimes I have to push, but this is my life, and my cancer indeed spread. (I am now considering fluciclovine or Mayo's Choline for in event my cancer is not PSMA avid).
My focus to not solely rely on PSA and to be out ahead of this beast with purpose to delay, if it comes to it, ADT and thereby CR chemo for as long as possible.
Yes it does help. I believe my urologist is "being out ahead of common practice" My undetectable has been <0.14. I could ask for an absolute PSA test showing results to as low as .01 (as was done by my RP surgeon/urologist.) I feel sure my current urologist will require both scans with my 6 month follow up, later this year, after this weeks appointment. I am now scheduled to just doing bloodwork on the 15th for my appointment on the 20th. Thank you for your reply. Greatly appreciated!
there are disparities about what PSA value to rely on for best indictor, and some in this group seem to discount and even despise ultrasensitive testing. I find using tests that report to <0.010 critical to staying ahead of this beast .
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