Time for Salvage Radiation?

[Clouds_69]

Following my prostatectomy in Oct 2018, my PSA was undetectable until May last year when it started to increase: 5/20 0.02; 8/20 0.03; 11/20 0.03; 4/21 0.06; 10/21 0.10.

The RO I was referred to recommends salvage radiation (33 treatments over 7 weeks – 66 GY total). He also suggested a Decipher test; I’ve asked that this be done.

So TA’s Review (Oct 18, 2021) and other recent posts came at an opportune time for me. As I read TA’s Review, it seems I am borderline for an “adverse pathology”: my PSA was < 0.5 at time of recurrence, I turn 80 next year; and my PSA doubling time is < 1 year.

Are there reasons not to proceed with salvage radiation right now?

TA, which RO’s in Madison, WI would you recommend? I get most of my healthcare through UW Health, but I’m not restricted to them; what about SSM Health Dean and Turville Bay? Also, should I contact an MO, and if so, who would you recommend?

[Tall_Allen]

You can reduce the number of salvage radiation treatments to 26. In fact, the clinical trial proving that was done at UW Madison. (I'm not sure which radiation oncologist, but Tim Kruser was the first author of the study):

prostatecancer.news/2016/08...

[Clouds_69 in reply to Tall_Allen]

Thanks for the reduction recommendation and the link to the UW Madison trial, TA. I hadn’t heard this was where it was done; it seems Tim Kruser is no longer here. I’ll follow up with my RO about the trial.

[Hidden]

I'd get a second opinion.

[Justfor_]

Are you aware that there is a high probability (different studies report occurances of 20 to 50%) the source of the PSA being distant, or local but contoured out to spare organs at risk, from the irradiation field?

[Hidden]

I Really don’t know clouds at all! We are not doctors . Sorry for the psa . But It’s not much of an uptick . However , please talk to a mo ,hopefully one specialized in APC . I d like to hear what they would say ? Good luck . You will do what is best for you .

[Hidden in reply to Hidden]

Joni ❤️

[Hidden in reply to Hidden]

❤️

[Clouds_69 in reply to Hidden]

Thanks, both of you, for your 2nd opinion advice and support.

Here’s a recent article about a visit Joni made to Madison in 1976, a decade before my time.

wisconsinlife.org/story/jon...

And no, my Clouds isn’t a reference to Joni’s song – it’s a family vacation home with many happy visits while growing up and then with a young family. 😊

[Hidden in reply to Clouds_69]

A family vacation home stays in mind ,good times! I Was 15 in 1976 . Thank you for Joni stuff . I loved that song . I was a “ girl watcher “ back then now retired I’m a cloud watcher . The skies over Az are wonderful . Good luck in happiness no matter what . Many thanks ! Scott ✌️

[Hidden in reply to Clouds_69]

Be happy to share my opinion about your situation. You can private message me anytime if interested.

[Jmr11820]

I had adjuvant RT after my post prostatectomy DECIPHER came back high risk. I did not have ADT because of my low PSA as well as a PSM. I’m only a little over 2 years post surgery but my last 4 PSA tests, at 4 month intervals, have been 0.00. Most recent one was today. I believe that DECIPHER has changed the criteria they use to establish risk of metastasis as well as PCSM. I was told by them they couldn’t run the numbers on my tissue sample because the prostatectomy sample didn’t have enough tumor to do a post prostatectomy analysis in the first place and that they had to use a biopsy sample in my case. Sounded like BS to me, but I still agree you should have some type of genomic test. Good luck!

[doc1947g in reply to Jmr11820]

Sounds like a surgeon was quick on the knife.If the only tumor was the biopsy then it was removed.

[Jmr11820 in reply to doc1947g]

Yeah I don’t understand what happened getting my tissue sample from pathology to DECIPHER.

[Hidden in reply to Jmr11820]

That’s the rub with Decipher. They can only examine what they’re given.

[Clouds_69 in reply to Jmr11820]

Yes, that does seem strange. Good luck with your regular PSA's. I hope they remain zero for a long time to come.

[j-o-h-n]

Greetings: Clouds,

Radiation - I've posted this before so to those people who have already seen this please forgive me.

I had 8 weeks of salvage radiation to "the bed". 5 days a week (not weekends) for 8 weeks minus 1 day for a total of 39 sessions at MSKcc. The actual radiation was like getting an x-ray by my dentist. I never had any side effects during the whole 39 sessions. However, 2 years later my left urinary tract was "fried" as per my urologist (or from passing prior kidney stones he was not sure). So, I had to have a urinary stent placed up my urinary tract (through my willy which is really nothing - sounds terrible but it's nothing) to aid in passing my urine (which was never a problem anyway). So I had stents in and out every three months for many years and now I'm stent free, However today 15% of urine from left kidney and 85% from right kidney, but not a problem. So make sure you get a good radiologist. Also, I don't know if this would apply to you but guys here recommend SPACEOAR HYDROGEL to be inserted for protection of parts of your body. Make sure you ask your R.O. about the spaceoar and make sure you ask here on this forum before getting fried.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/16/2021 6:44 PM EST

[Steve507]

Your treatment of RP and subsequent PSA progression very similar to mine. I did salvage last January and last tested in October at PSA 0.005

Cured

[slpdvmmd]

I might want to do a PSMA PET to increase reliability of conclusion (as pointed out in another comment after this time period is a significant percent chance could be elsewhere) that source is the prostate bed.

[dans_journey in reply to slpdvmmd]

Hi. I had a PSMA PET scan at UCLA on 30 November 2021 with a PSA of 0.22 taken in October 2021—more than twice the level of the OP's PSA level of 0.10—and it didn't pick up any sign of cancer, either in the pelvis or distant. That's both good and bad. I knew going into the scan that it had, at best, a 40%-50% chance of picking anything up at my PSA level. Just 5 weeks later, on 5 January 2022, my PSA was 0.26. In the OP's case, it's premature to go for a PSMA PET scan based on his PSA level.