PSA post Salvage Radiation

[Silverlings]

Prior post: My husband, at diagnosis had 3+4 on a couple of samples and chose to have surgery. He had clean margins and reached undetectable PSA after Prostatectomy. Near the end of 5th year after surgery his PSA became detectable.

He did salvage radiation at .09 PSA. His PSA went down to .08 after 3 months and to .03 after 6 months.

Update:

At 9 months it went down to .021 and we just got his results from 12 months test and it’s gone up to .033. We meet with the Urologist tomorrow. He hasn’t been on ADT, is that the next step? He’s BRCA2 positive. We’ll also make an appointment with his oncologist . I appreciate any guidance/help on what we should ask/research as I’m quite new to this and, of course, worried.

thank you!!

[Tall_Allen]

Still way too low to do anything about.

[ron_bucher in reply to Tall_Allen]

Debatable.

His salvage radiation did not produce undetectable PSA, so his cancer is continuing to grow.

It's his choice which risks he wants to take. Waiting for the next treatment has its own inherent risks.

For me personally, when I know my cancer is growing, simply monitoring PSA causes too much anxiety. I've had good success in getting treatments more aggressively than most, and in keeping my testosterone as long as possible.

[Tall_Allen in reply to ron_bucher]

There's no evidence that any treatment is beneficial at PSAs that low. But if it helps you feel better psychologically to do something when you feel so out of control, there may be some merit.

[ron_bucher in reply to Tall_Allen]

I assume you are referring to trials when you state "no evidence". Trials are great for making public health decisions, but every individual patient case is unique with regard to benefits and risks.

I personally got the benefit of 4+ years of additional undetectable PSA without ADT by getting treatments when my PSA hit 0.06 and had doubled in about six months.

[Tall_Allen in reply to ron_bucher]

Evidence is a term defined by medical science.

I'm glad that you believe you got some benefit. But (1) how do you know what would have happened from a different strategy? and (2) undetectable PSA is not the goal, survival and QOL are the goals.

[ron_bucher in reply to Tall_Allen]

1) No way to know for sure, but my cancer has both responded to treatment and recurred multiple times. That tells me it is persistent and threatening at some point to both quantity and quality of life.

2) Undetectable PSA is of great comfort to me because it is a fairly clear indication that at least my cancer is not growing quickly if at all. I'm planning to live another 15-20 years, and am doing everything possible to keep my testosterone normal so I can have my best quality of life. Side effects from all my other treatments have been mostly temporary and minor nuisances that are well worth my current quality of life and health.

We can only make decisions for ourselves, and share how we feel about our own decisions. We should not try to make decisions for others, especially clinical decisions.

[Tall_Allen in reply to ron_bucher]

Every person obviously makes his own health decisions. Some want to be as informed as possible. If you don't, that's certainly up to you.

[Silverlings in reply to Tall_Allen]

Hi Again, it’s been three months and my husbands PSA went to .06 which doesn’t seem good given he was .03 just three months ago. Is it still to early to do anything about? When do we do something. Trying to keep anxiety in check but be well informed and not look back thinking we could have or should have done something sooner.

Thank you!

[Tall_Allen in reply to Silverlings]

Yes, still too early!

[addicted2cycling]

Rx = 1 chill pill now and wait a bit for future results

p.s. = I'm not a Dr. but did stay at a Holiday Inn Express

youtube.com/watch?v=eHCTaUF...(Not working as expected?)

[j-o-h-n in reply to addicted2cycling]

Now that's funny................ In that vein (pun intended) I had an interview last week with a new surgeon who I think doubles as the owner/worker of a food truck............

Note: I wish to offer my apologies if I offended anyone regarding my so-called humor about "race" or "misogyny". To me, humor is boundless and since we entered this word crying, I thought it would be a good idea to exit laughing.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/19/2023 8:46 PM EST

[richealth]

I also had a prostatectomy and salvage radiotherapy. I do not want to have ADT due to the side effects. My oncologist arranged a PSMA PET/CT scan. A small tumour was detected and this was treated using SABR, just over a year ago. My PSA has fallen and I am currently awaiting the result of a a recent PSA blood test. I hope you progress well.

[JEKNY]

I have very similar story Prostatectomy in 2008, Salvage Radiation 2014, PSA becomes detectable 2021 (0.21) it has remained at 0.3 since. Urologist says typically we will watch it until it gets to 10.0.

I have since been diagnosed with CLL (2019) which brought on a case of Autoimmune Hemolytic anemia which I am being treated for.

I would suggest you relax if possible. Be positive.

[Bruce66 in reply to JEKNY]

Is your Uro waiting until 10.0 or 1.0? Want to be sure I read that right.

[JEKNY in reply to Bruce66]

I believe he said 10.0 . I get my PSA done annually and it has been steady at 0.3.

[ron_bucher in reply to JEKNY]

I suspect he meant 1.0. Congratulations on your success with salvage radiation (as I had for 7.5 years), and I hope your PSA stays flat.

[ron_bucher]

With the caveat that every case is unique...

As you can see in my profile, in a somewhat similar situation I got another 4+ years of undetectable PSA with triplet therapy that included nine months of Lupron + docetaxel + prophylactic radiation of lymph nodes above the local area (I didn't want the risk involved in waiting for my PSA to go high enough for tumors to appear on a scan).

[TJGuy]

So if he has been tested with a ultrasenitive PSA test 6 weeks post RP his result would have given you some ideas.0.03 or higher it is likely he would have reoccurrence

0.02 or lower likelihood he would not have had reoccurrence.

What was the salvage radiation IMRT? to pelvic bed? and whole pelvic?

So the radiation likely killed all PC within the field of radiation.

At this point you NEED to find your remaining PC with a PSMA scan. It could be a single point, or multiple.

You should watch many of Dr Eugene Kwon's MAYO clinic Rochester MN videos. To explain where your at.

Your PSA is too low to do anything at this point. You will need to monitor it and see where it's going and how fast. You will likely let it rise and get a PSMA scan at 1.0. If that doesn't find it a plan of when to scan again will be determined.

Once you find the point(s) of PC, a course of action will be determined.

[Silverlings in reply to TJGuy]

Thank you. I believe his radiation was whole pelvic, and IGRT. Your feedback is what we heard during our doctors visit yesterday, as well.

We’ll monitor very closely and take it one step at a time. Doing our best to “put this in a box” for another day and enjoy Christmas with loved ones.