hormone therapy and Salvage radiation with PSA at 2.41

[Jackleh]

I have had two radiologists recommend hormone therapy with salvage radiation with my PSA at 2.41. My choline PET scan shows only a local re-occcurnence at the prostate bed. A follow up biopsy of the prostate bed locates the concentration of prostate cells in my prostate bed. Markers where the five core samples were taken from the prostate bed were left at the core sample sites. PC was found in one of five core samples. The marker for the core in which PC was found will be used by the radiologist to guide the application of a little extra radiation. (7200 units of radiation in the area of known re-occurnece with 6600 units of radiation to the rest of the target area of the prostate bed). I have appointments with two medical oncologists within the next week. It goes without saying the best chances for no further re-occrence after radiation would have happened with radiation with my PSA under 1. I am where I am with respect to PSA. Other people's experience with radiation treatment with a PSA above 1? Questions for the medical oncologists? Questions for the radiologists?

[pjoshea13]

Jack,

Are they talking of short-term ADT with radiation? I'd be wary of anything more.

Here is an old (2005) paper. It starts:

"Androgen deprivation is an established treatment regimen for disseminated prostate cancer; however, its role in patients with localised cancer is less clear."

ncbi.nlm.nih.gov/pubmed/?te...

"6 months' androgen deprivation given before and during radiotherapy improves the outlook of patients with locally advanced prostate cancer."

-Patrick

[Jackleh in reply to pjoshea13]

Two months or so of hormone therapy prior to radiation and a continued two months of hormone therapy during radiation.

[Break60]

Like you say "it is what it is". No sense fretting about waiting at this point. You're fortunate that it's gland contained.

Bob

[bldn10]

This just my personal, lay, take on this, but I think the whole PSA level aspect reflects the recently ended era in which we had no scans to find recurrent PCa. From the SRT perspective the main question was is it out of the bed yet? Not having a scan to answer that, it stood to reason that the lower the PSA, the lower the probability that the horse was out of the barn. That proved to be an accurate hypothesis.

But now things are different in that we have scans that can show, almost regardless of PSA, if there is any PCa outside the bed. In my case I was 14 years post-RP w/ PSA that had been slowly rising to 10 and then shot up in a mo. to 30. I immediately got on ADT3 and then had SRT last summer based on a C11 Acetate PET. It is still too early to declare victory, and I surely almost blew it, but so far my PSA is undetectable.

[GARunner1 in reply to bldn10]

Just my understanding and lay opinion, but not sure about the statement from bldn10, "...we have scans that can show, almost regardless of PSA, if there is any PCa outside the bed." I believe that most of the advanced scans do have a PSA threshold. My PSA started to rise from undetectable 17 months after a prostatectomy. I had a C11 Acetate scan with a PSA of 0.2 and it showed nothing. It subsequently rose to 0.3 and I had 6 months of Lupron and 39 IMRT treatments (70.2 grays total) which ended in March. Waiting to see if this did the job. Just one guys experience.

[bldn10 in reply to GARunner1]

"[A]lmost regardless of PSA" - that takes into account the low thresholds.

[Hidden in reply to GARunner1]

My PSA is undetectable after surgery but my urologist wants to wait until PSA hits 2.0 before any more scans. It was only 2.7 when I was diagnosed. I think I need to dump my urologist and find an oncologist.

[j-o-h-n in reply to Hidden]

To WSOPeddie

Now you're cooking.... Dump the rickp asap....

Good Luck and good Health!

j-o-h-n Tuesday 06/13/2017 8:42 PM EST

[BillNIttles]

My post RP psa was a little above 1 when I got SRT five years ago. I had no scans, which meant they were shooting in the dark hoping they got it. (They didn't).

I believe your c-11 scan targeting your cancer is a better and more important predictor of success than your psa level. Adding short term adt can only improve your odds. Hit the bastard full on!

Bill

[Jackleh]

Thank you for your encouragement, Bill. I have fretted about the higher then ideal PSA for beginning radiation therapy.

[petercraig2]

I'm a big advocate of scans using prostrate specific marker agent (PSMA) and feel they should be available to all if PSA is not 0.0 after initial surgery or radiation.

All my scans were clear after surgery and I was referred to Charite Institute in Berlin for PSMA scan which showed two very small lymph tumors in my lower abdomen.

Struggling to get a suitable follow-up back in Canada but at least I know not mets in bones and early identification means early response for hopefully a better outcome.

Their scanning is same machine just a different injected marker agent so not sure why it is not standard practice for PC patients.

My thoughts.

Peter

[MateoBeach]

Two things Jackleh1) consider adding whole pelvic lymph node fields to the prostate for better (proven) salvage RT.

2) 6 months of adjuvant ADT with SRT May be sufficient with a PSA <1. However please read my post and referenced article on “Androgen Flare”, posted today, about the best timing for starting the ADT simultaneously with the start of the RT, and NOT two months before. Paul