Salvage radiation is in my future. What kind / technique is available for Salvage radiation?

[Keniszen]

hi, I have a RO who says I am being observed for possible salvage radiation. I had a RP about two years ago with a Gleason 9 and stage T3a. My post RARP PSA was not detectable. However, Recently my PSA is creeping up.

I think at PSA of 0.1, the Salvage RT process will begin.

Are there several techniques of salvage RT to whole pelvis area and nearby lymph nodes?

IGRT is available locally, but is Proton Beam radiation (or other types RT) more precise or likely to have fewer side effects?

Hormone therapy will be also be used in this process? Should I ask about orgovyx ( relugolix) pills?

thanks for any feedback on these topics.

Keniszen

[Justfor_]

Have a PSMA PET scan before going to sRT, yes - yes - yes, at a PSA as low as 0.1. Best photon machines for sRT are MRI guided lineacs (Elekta Unity 1.5T mostly deployed in Europe, another US make over there). In my personal case I am pushing sRT down the road with my Bicalutamide maneuvers (documented in a like-titled thread).

[Keniszen in reply to Justfor_]

I will ask for a PSMA PET - Pylarfy- . Hope the Medicare plan will approve it. Not sure the Auxumin scan is a valid backup plan?

I meant to say Intensity Modulated RT, but I do not really know the exact machine in use in my town.

[Tall_Allen]

The advantage of getting treated earlier, before PSA reaches 0.35, is you can avoid ADT and pelvic lymph node treatment.

There is no known advantage to proton beam. I do like Viewray MRIdian or Elekta Unity because they can correct for motion of the prostate bed, while fiducials are difficult to place in that soft tissue.

[Keniszen in reply to Tall_Allen]

I have never heard about the PSA of .35 and then the need ADT. I think the discussion is to do short term ADT therapy ( like 6 months?) versus long term therapy (more than a year?)

I will ask about the machine name at my next RO visit. My RO has not mentioned anything about Fiducials, so does most everyone use fiducials who undergo salvage RT?

[Tall_Allen in reply to Keniszen]

SPPORT found there was no benefit to adjuvant ADT when PSA <0.2:

prostatecancer.news/2018/10...

It also found no benefit to whole pelvic radiation if PSA<0.35:

prostatecancer.news/2022/05...

I guess I wasn't clear. Fiducials cannot be used with SRT.

[Keniszen]

Tall_allen,

Thank you for the feedback on Fiducials. I can scratch that question off my list.

At my next PSA (at three month interval) , I will try to calculate my doubling time. If a fast doubling time ( like about three months), I thought the more aggressive plan to use ADT was to be considered.

My RO said to begin the salvage theraphy after I have two PSA reading at 0.1 or higher. So I likely will be about PSA of 0.2 when the ADT is given?

Are you saying to just do pelvis bed and not the whole pelvis area when PSA is <.35?

Does the whole pelvis area RT lead to more side effects than just doing the pelvis bed RT?

Thanks for the informative links. My mind does not easily see the nuances within the studies. But I will keep reading and try to understand the report better.

Keniszen

[LowT]

If PSMA PET CT is negative you may want to do a prostate MRI. I had RARP 2016 with recent uPSA reaching 0.11. MRI picked up new nodule (0.4 x 0.9 cm) in prostate bed that enhanced with contrast. PSMA PET CT was neg. At this low level PSA the PSMA usually will not pick it up. Medicare now pays for the PSMA as it was suggested my radiologist because of the MRI which showed the nodule that enhanced with contrast.

[Keniszen in reply to LowT]

Thanks, so what does the CT mean as part of the PSMA PET CT?

And is the MRI part of the normal steps before undergoing salvage radiation?

[RMontana]

Keniszen, read my "If only I had known" list of things I would have done differently...focus on my experience with my sRT (salvage RT)...dont do anything until you make sure you dont have met...I insisted on a PSMA PET at 0.13 PSA...I wanted to make sure I had no spread before I treated my pelvic area...dont know if you are on ADT or not...but read over my lessons learned and see if anything helps...e.g., MAKE SURE you have baseline measurements of every thing... for example knowing your PSA at the start of sRT will allow you to use Nomograms later to predict outcomes...Bone Density, HEMO count, blood pressure averages, A1c...the works...read my laundry list...TNX

healthunlocked.com/active-s...

[Keniszen]

I understand to have PSMA PET before salvage radiation. Let’s see what my RO does? Think he does not want to wait till my PSA increasing pas the very low PSA

Did the RO write the order to get a Bone Density test?

[chefjlu]

I was diagnosed 4.5 years ago w/stage 3a and Gleason 9 - RP about 6 months after diagnosis, only 1 lymph node showed cancer activity - undetectable with no other treatment until Nov 2021 when PSA rose a bit - PET scan in Jan 2022 to see what and where - 1 lymph node showed (small) - Radiation in May & June with ADT & Abiraterone started prior to - no issues with any of it overall other than some light hot flashes. Will add that my Doctors all agree that my exercise and activity level (high) and adjusted diet have helped in all of it.

ADT and Abiraterone before starting radiation assists the effectiveness of the radiation. The PET scan determines the placement of the radiation - mine was pelvic and prostate bed to start and then narrowed to specific point by end. As for Orgovyx I tried it first, after 6 weeks ineffective in lowering Testosterone - given Firmagon for 1 month, then Lupron 6-month shot. My oncologist has several patients who did not respond to Orgovyx. Not a bad review, just we are all different and don't respond to everything the same.

Don't be afraid to ask questions, search out information, get a second opinion. There are side effects and they vary from individual to individual as well as their severity.

[Keniszen in reply to chefjlu]

thanks for your reply as I have a similar history.

I will look up abiraterone and the purpose of it

[chefjlu in reply to Keniszen]

Abiraterone is generic Zytiga - my insurance pays all but $20 every 30 days. It is FEDEX sent to me by ONCO360 every 15 days.

[Keniszen in reply to chefjlu]

never heard of ONCO360 . Do you have any idea if they will accept my medicare Humana Premier RX plan ? Do you know if they charge about the same as getting from CVS or Publix? Looks like some of the prostate cancer drugs are super-expensive, while others are somewhat doable on my medicare RX plan.

[chefjlu in reply to Keniszen]

Don't know that, I'm a little over a year from Medicare. You can reach them at: onco360.com. They are a pharmacy specializing in oncology medicines. Prior to my insurance accepting, they had connected me with the manufacturer who had a discount program very similar. Very nice people, follow up with phone calls on how well you are doing, send care kits to help deal with side effects, they even sent me a beautiful throw to snuggle on the couch with. My oncologist connected me originally.

[Keniszen]

thanks, I plan to onco360 a call