Radiation at low PSA levels

[Peppertree602]

I saw an article or a feed somewhere for starting radiation for recurrence after RP that salvage radiation at around 0.05 level provides a higher potential for cure vs. waiting until it rises to 0.20+. Has anyone seen this article or statistic?

Tx

[Tall_Allen]

Only in some very high risk cases:

prostatecancer.news/2021/10...

[Peppertree602 in reply to Tall_Allen]

Thank you this is indeed where I saw it! Given my low PSA but my wonderful pathology 3 different ROs and my MO all recommended radiation and my MO as well said in addition to Orgovyx for 2+ years to add Zytiga as you mentioned to me last time. All feel cure is 80+% so we continue as advised

[Ahk1]

I didn’t see the article but I did SRT at .07 and it failed right away.

[London441]

Similar situation. I had a prostatectomy in 2019. Despite an undetectable PSA post op I was recommended a clinical trial right away with IMRT, abiraterone, 2 years of ADT and 4 cycles taxotere chemo. Treating residual disease with a very low or undetectable PSA wasn’t SOC then and isn’t now. But I volunteered anyway.

PSMA scans were pretty much not yet available at the time. I had 4+3 confirmed post op, but I had a good number of saturated cores, the adverse pathology you mentioned plus a positive node.

The ADT was shortened to a year on advice of my RO and MO. I sought a 2nd opinion who agreed. Both the surgery and additional treatment was at a major center of excellence.

Although the prescribed ADT was officially a year, my testosterone didn’t rise beyond castrate levels for 6 months, so looking back I considered it more like 18 mo.

Side effects were very manageable. I was 63 at that time. I am now 3 years since full recovery of T and am in good health, have remained undetectable throughout.

There isn’t any data I trust re: if and how long to wait to treat low PSA residual disease or appropriate length of ADT. Whatever length you choose, know that it is essential to help the radiation do its job.

However, you best also beware of the side effects. Belly fat gain, muscle loss, brain fog, probable total loss of libido, blood sugar rise, BP rise, hot flashes and cardiovascular issues are all quite common though certainly not in every man.

You have an advantage in that orgovyx (which wasn’t yet available when I was treated) leaves the body much faster than the other ADT drugs. Do you know what your baseline testosterone was a diagnosis? You should.

I’m sure your diet is fine. Forget the RIFE machine and ramp up your exercise if you’re smart. It’s much more important. Whatever you do now, do more. Everything will get harder, but it is the guaranteed way to thrive on ADT. Lift weights if you don’t already, it’s incredibly important. Aerobic exercise is essential also, but you need to address the muscle loss, and lifting will maintain your strength and minimize the persistent fatigue that ADT is known for. That fatigue is not caused by the drug, it is caused by muscle wasting from complete removal of T.

Great luck to you!

[Peppertree602 in reply to London441]

My testosterone was 480 and after starting Orgovyx dropped to 23 within 5 days and lots of muscle fatigue for sure but still do elliptical or rower daily for 40 minutes and 15 minutes of weights but will increase weights to 30 minutes of weights daily. Plus tennis 3 times a week at a high level 3.5 to 4.0 but more like 3.5 now days. I also put an infra red sauna in my new house and use it 3 times a week.

[London441 in reply to Peppertree602]

You will do very well I’m sure. And again when you’re done with the Orgovyx your T will recover quickly- one of best things about it.

[NanoMRI]

If one's hope is to not die from this disease nor face ADT/chemo/castration resistance, why give this beast time and obscurity? Although I was not considered 'very high risk' I learned this beast moves along on an individual man basis, regardless of population based medical staging schemes (British definition). If I could have a do-over with my RP nadir of 0.05, I would have multiple imaging methods and a blood biopsy. Better yet, I would have these investigations before my primary treatment decision.

[Peppertree602 in reply to NanoMRI]

I have .41 for decipher but TP53 and PTEN mutations and T3b plus IDC so radiation next week it is!!! TA's blog is super helpful and does show the earlier the better for potential cure. My MO and RO think 80% chance of cure for 5+ years given pathology

[NanoMRI in reply to Peppertree602]

IMO with three 'curative attempts', the sooner the better is simply logical. All the best with your attempt and hopefully all the cancer is within the radiation field.

[j-o-h-n]

Cure? Obscure.......

Good Luck, Good Health and Good Humor.

j-o-h-n