Am I headed for Radiation

[Elkguide]

hello all. Wishing the best to everyone. Just a quick question that I think I know the answer to. After RP in June 2023 pathology was Gleason 4~3 with SVI, clear margins, lymph node dissection negative, prostate 30% involved. First PSA test all at quest was an ultra sensitive post prostatectomy test (<0.02). 7-17-2023. On 9-25-2023 another post prostatectomy (PSA Icma) was <0.02. On 12-18-2023 post prostatectomy with Hama came back 0.02 ( no plus minus symbol) . On 4-10-2024 a PSA total test came back at 0.10…on 7-5-2024 a post prostatectomy with Hama treatment came back at 0.10 ….my MO decided to do a Psma-pet scan ( I know 0.10 is too low for test) came back negative. My question to all of you am I headed for radiation sooner than later and what type Imrt, Sbrt, would this be salvage radiation. Sorry a bit winded here. Thanks, very appreciative

[Cackalacky_cyclist]

Most likely is salvage IMRT to the prostate bed only, unless there is definitive lymph node or other involvement via scans. My RO was fine radiating the prostate bed with a low PSA without a positive scan but would not radiate anything else unless it was found on a scan. His reasoning was that area is the most likely after an RP. As you can see from my bio I ended up doing the pelvic region too 🙄. YMMV

[Elkguide in reply to Cackalacky_cyclist]

thanks Cackalacky cyclist. Love my bike rides also

[Tall_Allen]

What is Hama treatment? You can safely wait until PSA reaches 0.2, but you may want to make an appointment to at least talk to a radiation oncologist about salvage radiation.

[Elkguide in reply to Tall_Allen]

Good morning TA . Hama treatment is used for someone that has handled a hamster or rodent. Which I have never done. Don’t know why ? Thanks for your reply

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

Does that include eating one?

Good Luck, Good Health and Good Humor.

j-o-h-n

[Justfor_]

I followed a different path. My bio has the information.

[NanoMRI]

I 'waited' until 0.11 for my salvage RT - we missed as my cancer had already spread beyond the radiation field. IMO and experience 0.1 is not too low for imaging - I just had my third PSMA at 0.033.

I believe we must accept that with radiation we are shooting at least partially blind and that radiation may not get it all. Waiting gives this beast time to grow and spread. All the best!

[Elkguide in reply to NanoMRI]

Thank you nano MRI will look into finding a radiation oncologist

[Hawk56]

My, emphasis on my, clinical history (see attached).

When I had BCR, the clinical data put me in high risk, GS 8, Grade Group 4, short time to BCR (18 months). My urologist and radiologist wanted to do SRT - to the prostate bed only. I had seen data from clinical trials as well as Mayo that indicated in high risk BCR, often there was PCa in the PLNs and treatment that included radiating the WPLN and short term ADT (six months) had better outcomes - longer progression free period. They dismissed the idea, saying there was no "long term" data supporting it.

I acquiesced, against my better judgement and instincts. When my radiologist hesited before turning to talk with me at our 90 day post SRT consult, I knew, PSA had more than doubled, epic failure, she new it, my urologist new it. As I say, the past is the past, let go of it but learn from it. I never again let my medical team take a conservative approach. When the Director of Urology at a major NCCN Center told me he would only treat me using ADT monotherapy vice triplet therapy, I thanked him and left, went to Mayo, did triplet therapy, altered the trajectory of my PCa and perhaps saved my life.

You may be headed for a treatment decision sometime in the future, perhaps not now. If and when that time comes you may want to discuss doublet or triplet therapy with your medical team. A treatment choice may depend on additional clinical data such as PSADT and PSAV, results from imaging, age. co-morbidities....and your preferences on aggressiveness that may provide greater PFS outcomes from combination therapies for defined periods.

I've been on this journey 10+ years, three of those have been "on treatment..." So, seven years off. My current break has me once again feeling pretty damn good. Not that being on treatment changed my life much, Only radiation which restricts your ability to be away did.

Kevin

Clinical History

[Elkguide in reply to Hawk56]

Thank you so much Hawk 56. See urologist this morning. Hope he isn’t mad I brought on a m o. Will discuss bringing on a R O. The previous PSA was also a 0.10 and urologist said still under threshold for recurrence. Thanks again

[Hawk56 in reply to Elkguide]

If your urologist is, show him this...

PCA Medical Team

[SpencerBoy11]

Have a SpacOR done before the radiation treatment.

[Mgtd]

I had the pelvic area done at the same time as radiation. This was a precaution to hopefully stop micro spots of cancer there.

[Elkguide in reply to Mgtd]

thanks Mgtd hope you nailed that sob

[j-o-h-n]

When my doctor said do it, I did it.

Mine was a piece of cake.....but a couple of years later that cake turned into fried cake.

Make sure your shielded from those rays.

Good Luck, Good Health and Good Humor.

j--o-h-n

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

Thanks j-o-h-n so probably space oar or hydrogel. Not looking forward to that. The Urologist says we wait to next PSA test in three months. Last two were 0.10. in meantime got app with radiation oncologist to get him onboard