My husband had a radical prostatectomy in the fall. PSA at time of surgery was 7. First PSA test after surgery in December was 5.0. He went back in and had another PSA in January- 5.2. Just finished a MRI and PSMA testing session - found cancer in a nodule - not in the bones. PSA is now at 7.2. Original Gleason at surgery was deemed to be 4/3. He had lymph nodes tested at that time and no cancer was found in them.
Worried - what's next. I am assuming radiation. What are his odds of surviving this?
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Luvmyman
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I would expect that he will survive this for more than ten years. Statistically a lymph node met has the same overall survival as no lymph node met. If you would like to get rid of this nodule and lower the PSA value you can radiate this lymph node with SBRT. Or radiatiate the pelvis (ENRT) in case there are further nodules too small to be visible with a PSMA PET/CT. x.com/piet_ost/status/17877...
I agree on the statistics in this salvage radiation in this scenario is with curative intent and have good results.
Actually if offered, they might even treat you with WPRT to handle any Micro mets and, like you suggest, at least higher IMRT dosages to the affected lymph node or why not SBRT if possible
If there is one lymph node detected you might suspect Micro mets not seen as well so I wouldn’t gamble and definetily have whole pelvic radiation therapy and also hormone therapy started before salvage radiation.
If you get a chance read my bio. Was very similar. I was a four three. PSA near 20. Had robotic surgery. Had a rising PSA post-surgery. Did full pelvic radiation. It's been 2 years and I have had back-to-back PSA tests of undetectable. However I did have adjuvent ADT androgen therapy with the radiation. Have hope. There are some amazing people and their journeys on this forum that can help.
Runtrails, I was a 4+3 (biopsy) and after prostatectomy upgraded to 5+4. Rising PSAs immediately after, so started ADT. PSA now below 0.020 since October 2024. I want to avoid radiation's side effects and permanent damage to my pelvic tissues. Have been encouraged by the results of clinical trials and studies of estradiol, my own success with it and the experiences of several other men with long-term PCa suppression. My side effects are quite tolerable.
My question for you is, did you have side effects from the EBRT (External Beam Radiation Therapy), which is what my oncologists want me to take?
What my radiologist terms "curative" is only a likelihood of the cancer not progressing at the 6-year post-treatment point. I don't call that a "cure".
Concurrent with the radiation was my androgen therapy ( lupron) so some of the side effects such as fatigue it was difficult to define where it was coming from. But long-term the only side effect, assuming it came from the 35 rounds of radiation, is some mild bowel urgency. No incontinence, just have to head to the bathroom when those urges come. Not able to put it off. Especially number two. I definitely had side effects during the lupron treatment, especially hot flashes.
Tall Allen. I have a lot of respect for you and your knowledge in this area. I’m intrigued by the statement “may be curative.”
Gleason 4+3=7 with positive pelvic nodes status post 45 weeks prostate and node radiation. On Eligard starting adi+pred. Doctor never mentioned possibility of cure. Appreciate your opinion.
Maybe. Lymph is a slow-moving fluid (unlike blood), so if it is only in the pelvic lymph nodes (N1), it is possible it may be cured. But that's a big "if" -- even the best PET scans cannot see anything smaller than about 5 mm. So it may already be systemic, and therefore, incurable.
I had the same question after my unsuccessful RP, also G 4/3 with taken nodes clear. And I had it again after my unsuccessful salvage RT to prostate bed. I chose to not have ADT with the salvage RT for the common short- and long-term side effects concerns, and also because I wanted to get an accurate PSA as soon as possible. Soon after my salvage RT we knew we missed - my cancer had spread further than anticipated.
Prior to each of my four treatments I wanted as much investigative information as possible. Given the maximum loss potential I don’t do well with “may, might, could” etc. The findings (or lack of) on your husband’s imaging with his post RP PSA value would drive me to much further investigation before making a treatment decision. My investigative efforts have included additional comparative imaging methods, second radiology opinions, genomic/genetic testing and more recently liquid blood biopsy testing. After my salvage RT, instead of RT to pelvic region with ADT, and possibly chemo, I went for salvage extended pelvic lymph node surgery with the frozen section pathology method. I am certainly not recommending this, but despite the naysayers on this board, that decision seven years ago has proven to be a very good decision for me. Hope this helps. All the best!
My situation was similar. Duke MO suggested same path as Allen, except they recommended only 2 yrs each of Lupron and Abiraterone simultaneously. I’m about 8 months post-ADT. So far, so good. PSA has been undetectable. It’s way too early, but hoping I’m cured, and MO and RO say that there is a reasonable chance.
Hello, seems you are not in bad shape but remedial therapy needed. I had very similar result after RP, pelvic bed nodules and slowly rising PSA. I would suggest SBRT for cancer lesions identified on PSMA PET/CT scan. I had full 35 sessions f radiation of prostate bed and regretted ever after as bladder control never the same.
I subsequently with agreement of my Clinical Oncologist started transdermal estrogen patches (TEP) which very quickly reduced PSA to < .008 and been there for 8 years now. No night sweats, heart palpitations, no loss of bone density. Only downside is slight man boobs which with current mild breast radiation I understand has pretty much minimized that side effect.
Happy to share technical details if you are interested.
You can visit my profile and read my bio - I update regularly as my journey continues. It's been a bit over 6 1/2 years since diagnosis & 6 years since my RP. My Gleason was 9 - 1 lymph node found positive. My PSA has been undetectable now for over 2 1/2 years following Salvage Radiation & 2 years ADT (ended in May 2024). So at this point I am called "cured" - which is honestly remission. I continue to have blood tests as a check - and will have regular scans (CT & Bone or MRI) to keep a check on things. ---- Your husband has good chances for "cure" following guidance of Oncologist & Radiologist. There are no guarantees for any of us. However, a positive attitude - adjustment to your lifestyle - getting informed & questioning your doctors on the treatments prescribed & projected outcome.
Similar diagnosis as your husband. I bypassed the surgery route and went for IMRT radiation and whole prostrate radiation at the same time and ADT for 6 months.
Almost 2 years since radiation and off ADT and PSA is running in the 0.06 range. Tends to bounce around that average.
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Why not start therapy the moment you know you have PC?
PSA rise soon after surgery!
I am new here and started hormone therapy
New info from new oncologist
