Has anyone got cured by salvage radiation? My ex had prostatectomy and then his PSA never went down to 0 and rose from 0.2 to 0.5 he is having salvage radiation fright now. I hope he gets cured.
Salvage Radiation chances of cure, pl... - Advanced Prostate...
Salvage Radiation chances of cure, please share
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Choice125
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15 years ago, I was told that salvage radiation was not performed with "curative intent". So I wasn't upset when my PSA nadir was 0.3. I did panic a little when the next (3-month) test result was 0.8, but I'm still here.
I hope it goes well for him.
-Patrick
Has ADT (Lupron) been added to his radiation treatment? That improves the odds somewhat....What was his original Gleason score ?
No, not added, the original was GS 8, clean margins after the operation
I had salvage radiation 4 years ago. I never thought of it as curative. However, I just had a biopsy on that area which showed no cancer present. Since then my research doctor put me on xgeva to strengthen bones making it less likely for for a return of cancer to my bones.
Gleason 8 is a negative, no margin is a plus, no zero post RP is a negative. I wouldn’t bet on no recurrence.
Hi Break60
Running Tall Allen's nomogram shows something slightly different. While negative margins is typically a good thing. It appears if you have post prostatectomy rising PSA and had negative margins your chance of PFS is somewhat less than it you had positive margins.
Yes, that's why they didn't add the hormones, because they are shooting blind. They don't know where the cancer really is.
Talk to your MO about adding at least 6months of ADT, like lupron. Can do now. Improves success rate.
I would add the quality of life issue as a consideration as well. For a younger man there is an advantage to add ADT.
However, for example, I am 70 years old with a biochemical reoccurrence after radical prostatectomy in 2016. I made the decision to do salvage radiation only.
I had rather take my chances rather than
add ADT with it’s multitude of side effects.
It’s simply a choice between quantity vs quality of life...highly complex and personal decision. I wish you the best choice for your future.
Not everyone has horrible side effects from ADT. That's the hard part- choosing quality of life for some means taking ADT. Choosing QOL for others means not taking it. And we won't always know what the particular person's reaction to treatment will be. I guess true for any treatment.
Yes...hardest decision I have made in my life. Only time will tell if the risk was worth the reward.
Such a difficult decision! Hardest part for my husband, and everyone, is the "you'll never know" if the other choices would have been better or worse. Just have to live each day to the fullest and carry on💙
He is 69 and we have an energetic 7 year old. So quality of life is a factor. how many times did you have it? I think his is 33 or 39 ... I am not sure. How did it work for you? How far your PSA rose before radiation? What are your chances and how you cope?
I had 33 proton radiation treatments over a seven week period. Originally my Gleason score was 7 and my PSA was 4.8. After my RP in 2016 my PSA was undetectable. However about 18 months ago my PSA started slowly but consistently rising. When it reached .4 my doctors recommended I begin treatment and suggested radiation and short term ADT.
After much study and discussion with my wife and doctor friends I decided to take the gamble and forgo the ADT.
I had only few minor side effects from the salvage radiation and stayed active and exercised except for a short period when I was fatigued.
Even though I am 70 I feel good and want to have a rich full life in the healthy years I have ahead. I have decided that the chance of a couple of years longer life is offset by wanting to be vibrant while I am here. Plus a few years from now that may be breakthroughs in research that will recapture any time I lost. Finally, I have finally decided that maybe I will not live forever like I thought as a younger man...so I want to live my remaining life on my terms.
I will be happy to discuss further if any of this is helpful to you.
An energetic 7 year old? Is that a puppy? Or did you kidnap someone's child? I had energetic 7 year olds when I was in my 30's and that was a chore! (And a joy!) Bless you. And enjoy.
Consider: Using estradiol patches along with some form of ADT improves the side effects and QOL to a very great degree. Or for that matter you can use the estradiol Patch protocol alone to maintain "castrate levels" of testosterone, as long as it is monitored. I am going through this now to complete a short course of ADT in support of RT. Currently "nothin' but patches" and feeling very good. Though I did one injection of degarelix to get T down very quickly to castrate levels at the beginning.
I agree on this. My circumstances are similar and I just completed 3 years of ADT after RP and Radiation. Gleason 9 and PSA is undetectable with Testosterone essentially at zero.
Quality of life has been good although fatigue is real and probably the toughest to deal with along with sleep interruption.
I've known many men whose Psa went lower than 0.2 after an RP, maybe to 0.01, and for years, and then Psa began to rise. I've seen a man have RP, Psa went low, straight back up to 7 and he only got 3 months of ADT suppression, and Cosadex made Psa leap to 40, so all men often have a different response to RP, EBRT, and add on drugs like Cosadex, Zytiga, Enzalutamide, none of which give a permanent suppression of growth of most men's Pca.
I could not have RP in 2009 at age 62 because my Gleason 9 score with Pca well outside capsule meant I had to have 70GreyEBRT after 6 months on ADT followed by another 18 months ADT, then Psa went back up to 8 when ADT ceased, so EBRT did not appear to work well, so ADT recommenced, Psa went to 0.2, but in 2016 began to rise fast and I was first man in Oz to have additional 31Grey EBRT to PG to avoid risk of local spread where the initial treatment was EBRT. Thus total radiation to my PG was 101Grey. Cosadex was added to ADT, and Psa went from 5.6 to 0.4 then back up after 6 months, and so it seemed I had radiation resistant Pca. Some guys who have RP + following EBRT may not get much benefit.
After Cosadex I had Zytiga; it gave 8 months suppression, then chemo which did not work at all, and this last year I got lucky with Lu177 because before Lu166 this time last year Psa was 25m but its now 0.32, and not the slightest ache or pain due to any mets. I cycled 245km this last week with 28km this am at average 24.5kph and there's a few hills and traffic delays, and at 72yo, that's real good for me. I did another 46km before getting home, so I am in very good health now and onco doc is well pleased. For how long is anyone's guess. I have just survived 10 years since diagnosis but if Lu177 had not worked, I might be in palliative care now.
I am fully continent, but all sexual ability for hard on or any pleasure has been totally exterminated. Its OK, I gave up trying to find a partner in my 50s.
Patrick Turner.
The chance of recurrence for most people is 50% depending on Gleason score (inverse relationship). I heared of someone with score 8 (4+4) who cured even with positive margin and SV invasion PCa.
I had salvage radiation 7 years after my prostatectomy. My PSA was 0.22. After salvage it went to 0.01 for 2 years. Currently I’m at 0.22 again. So go figure 😒
Unfortunately, it did not work for me. I had an RP for Gleason 9, and that definitely put a damper on the cancer...for about 4 months. Went on ADT and salvage radiation...my psa continued to rise and they stopped the radiation because it was having no effect. The put me on apalutimide and that drove it into remission
I had same follow on after my RP in 2010 I then had 8 years of Casodex tablets daily which kept PSA low until 2 years ago. Now on Aberaterone and prednisone daily and Hormone injection every 6 months. All stable at present but I just get on with life enjoying travel and my now 8 grandchildren no one of which were born when this journey started.
Keep positive and try at best to put this disease to the back of your mind is my philosophy, look ahead all the time to keep up to date on what next with solutions to explore when the time comes.
Life is too short to keep worrying about things you have little or no control over!
in reply to Engraver68
8 new grandkids is an accomplishment . I’m sure glad that you’re here to see them . It’s a great story . Thanks
I had it. First 9 months with full testosterone is holding. We’ll see in dec if another 6 months held. Based on the calculator I have a good chance for some good length. Then again with the original RP I was not supposed to be in this position based on stats.
I am 46 so a ‘cure’ would be great. But will I go 30-40 yrs. who knows
However they had me do 7 months ADT even with GL7. I figured throw everything at it. This was at MSKCC
Only time will tell
It is difficult to predict because no matter how similar, every patient/situation is unique. That being said...
My story is similar, biopsy of gleason 8. Had a RP at MSKCC in Oct of 17 with negative margins and the surgical pathology lowered my Gleason to 7. Everything seemed to indicate that was the end of it. My PSA was .68 in Dec and continued to drop over the next few months, but never dropped to zero and started going up again in March. New images found a suspicious lymph node. I setup with a radiation oncologist at MSKCC and started ADT in July and specifically waited until Sep to start radiation so the ADT would weaken the remaining cancer before radiation. I would def ask why they aren't doing the hormone therapy with the radiation. It improves chances of success. I stayed on it through April of this year (9 mos). Going for my 6 month follow up PSA tomorrow.
As for a cure, I figured chances were practically nil for me, since given the neg margins it had to have gone metastatic at a microscopic level. However my oncologist said a cure was possible but he said it was realistically about a 40% chance because in my case it was still regional to the prostate bed.
Stay positive. Even if it isn't cured, we can still fight it and enjoy our lives ADT the same time.
Love, strength and courage to you and yours in the fight.
Mark
Gleason 7 in 2000. Treated with combined brachytherapy and external beam radiation PSA nadir 0.01. Maintained for seventeen years.
PSA rose to 1.45. Axumin scan identified lymph node metastasis.
Eight week’s tomotherapy ( radiation) fall 2018
Nadir 0.08. At present ( 12months post treatment start). 0.13
No other treatments
My dad's psa went to .9 after surgery. He had salvage radiation 10 years after surgery. His psa returned to 0. He lived to 93 the Gleason score was 7.
"I hope he gets cured." We all hope to be cured, but there is no such thing with Prostate Cancer. However he can go into remission and fight the beast for many years.
Would you be able to tell us more about your ex?
Age, Location, Treatments to date, Scores (psa, gleason), Treatment center(s), Doctor's name(s). All information is voluntary but it helps us help him and helps us too.
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 11/10/2019 5:27 PM EST
His GS is 8 and it was deemed aggressive. The margins after operation were clear, I don't know what his PSA was before the operation, I will ask. He is looked after in The Carlo Fidani Regional Cancer Centre, Mississauga, Canada. He is 69
Thank you for your reply. You may want to copy that info and paste it under your User ID on your home page for future reference and for members to view. Give him our best wishes in fighting the beast.....
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 11/11/2019 7:09 PM EST I salute every veteran today and everyday.
His PSA was 8.7 before the surgery
I wanted to let you know that I had a radical prostatectomy in July 2016 but over time my PSA started to rise. My urologist wanted me to immediately have radiation when it rose to .1. I had a second opinion from a Seattle oncologist who said I could watch and wait until it is .5 before starting radiation. I decided to start radiation when my PSA reached 3.6. After 40 radiation treatments my PSA dropped to 1.2 and 3 months later it was undetectable. I did not have any ADT. I am hoping it continues that way and hope the same for your ex. Chances are your ex will be around for a long time. They say most men die with prostate cancer and not because of it.
Nomograms do not say much about an individual patient as they are computed from averages of hundreds or sometimes thousands of patients.
What they do say is if a doctor has a hundred patients with the same Gleason Score, etc then after RT a certain percentage will be cured, etc.
It says nothing about which patients will be cured.
Some patients will have a more aggressive cancer, stem cells already outside the prostate bed, etc while others will not.
I've actually seen several instances. Successful even without ADT. Try PCSPES first to drop that PSA like many of us have.
I totally agree. PCSPES saved me and still does.
I have seen some cured with this type of secondary radiation. Just stay away from the Lupron. That is where I screwed up.
Why stay away from Lupron?
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