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- Jul 6, 2004
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I was sent a 61 yo man who had prostatectomy 1.5 years ago. Path was moderate volume gleason 3+4 negative margins/ece/svi with initially undetectable PSA, initial PSA was 11. A year after prostatectomy his PSA started rising was 0.2 then 0.4 4 months later then he was sent to me . They happened to do a bone scan outside and fond a small lytic/sclerotic lesion 1.4 cm in the sacrum read as concerning (no bone scan for workup). At that low of a PSA I was up in the air about what to make of that. No high risk features for local failure.
I had a not dissimilar case that ended up being metastatic disease so I though I should at least have IR review this. They said they could attempt biopsy which they did. Path was read as concerning but not certain. I repeated the PSA and now it is 0.9 ng/ml 3 monts after last draw. Just curious what you guys would do at this point. Feels to me like his doubling time is quite high, he also did not have significant risk factors for local failure (MRI negative for anything in the prostate bed, no palpable nodules, shows the sacral lesion as concerning)
I had a not dissimilar case that ended up being metastatic disease so I though I should at least have IR review this. They said they could attempt biopsy which they did. Path was read as concerning but not certain. I repeated the PSA and now it is 0.9 ng/ml 3 monts after last draw. Just curious what you guys would do at this point. Feels to me like his doubling time is quite high, he also did not have significant risk factors for local failure (MRI negative for anything in the prostate bed, no palpable nodules, shows the sacral lesion as concerning)
