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Advanced Prostate Cancer
Center of Excellence
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Richard Peksens
Jan 12, 2018
Some transient elevation of PSA can occur following prostatectomy, but an elevation after 4.5 years would be suspicious of biological recurrence. The "definition" of recurrence would normally be 0.2 rise in the PSA above the nadir, but based on the SV/lymphatic invasion at initial diagnosis, intervention with "local" IMRT to 66 Gy, without additional LHRH-agonist, would seem appropriate based on his young age and risk factors. There are also prostate antigen PET scans which might help to r/o lymphatic spread.
Art Auster
Jan 12, 2018
My experience and sense with this non cancerous tissue left after surgery concept is that, of course, it’s possible, but very unlikely, suggest don’t bet on it
Keith Ritchie
Jan 13, 2018
Re Richard Peksens suggestion, see 2nd paragraph of the case presentation. Already had postoperative radiation therapy 66 Gy completed 8 months post-diagnosis ( when PSA undetectable ). This was not IMRT but standard conformal radiation.
Or are you suggesting additional radiation in view of possible spread on the left side of the prostatic bed?
Richard Peksens
Jan 22, 2018
I noted that the 66 Gy XRT was appropriate due to the evidence of SV disease at the time of prostatectomy. The issue is to determine (+) biological recurrence and location. This is possible utilizing a PET scan which will attach the isotope to a prostatic antigen as "normal" FDG scans are not very effective is prostate disease. Obviously, treatment decisions would be based on the results of the PET scan. Local or LN recurrence would probably warrant a combination of abiraterone/steroids/LHRH-agonist.
Vandenbulcke Jean
Jan 28, 2018
Pet- psma when psa between 0,3 and 0,5 ng/ml
Apr 19, 2024
Pending Moderator approval.
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Richard Peksens
Jan 12, 2018
Art Auster
Jan 12, 2018
Keith Ritchie
Jan 13, 2018
Richard Peksens
Jan 22, 2018
Vandenbulcke Jean
Jan 28, 2018
Apr 19, 2024
Pending Moderator approval.