Question about radiation

[DLetterman]

I had prostrate cancer in 2019 and had my prostate removed. My PSA is now detectable at 0.12. It has been at this level since January. My oncologist/radiologist is recommending I have radiation to just the prostrate bed for 8 weeks. My PSMA PET scan came back negative, and nothing was detectable. I am meeting with my urologist on Tuesday. What questions should I ask? I feel that since nothing has shown up and my PSA has been constant for the last several months I maybe should wait and get rechecked. Also my oncologist said it would only be 80% effective. I worry about what radiation can do 15 -20 years down the road. What would you do in my case?

[Justfor_]

I had similar to yours conditions and reservations regarding salvage RT. 16 months ago I started dealing with it in a non SoC manner that for the time is paying off. Detailed documentation with monthly updates can be found in my Bicalutamide maneuvers post.

[LowT]

For myself prostate mri with and without contrast showed new enhancing 0.4x0.9 cm nodule in prostate bed. PSMA/PT CT was negative. PSA 0.1.

[DLetterman in reply to LowT]

Are you saying their is a better scan than the PSMA/PT? If yes, where was your test performed. My doctors are at Vanderbilt.

[Channelhomec]

How old are you gleason score , I would not give the cancer a chance to grow> was in a similar situation as you radiation was no problem .....

[DLetterman in reply to Channelhomec]

I’ll be 56 later this year and my Gleason score was a 7.

[Justfor_ in reply to DLetterman]

You are very young with statistically 3 decades in front of you. With 1.55 per 100 patientyears odds for second cancer incidence due to the irradiation treatment, at your 86 this can mount up as high as 46%. I have posted the particulars of the paper I am refering to in a thread entitled "Heidelberg".

[ron_bucher in reply to DLetterman]

I was 56 when my post-prostatectomy PSA reached 0.12. Following the standard of care, I waited until my PSA reached 0.20 to get radiation which gave me 7.5 years of undetectable PSA. I wish I would have NOT waited. I think earlier radiation might have given me a better chance for a longer remission.

[ron_bucher in reply to ron_bucher]

p.s. Radiation didn't give me any major side effects - just need to pay a little closer attention when the urge to defecate happens (only one or two "accidents" in 15 years, and only because I didn't pay enough attention).

[DLetterman in reply to ron_bucher]

Thank you! I have been nervous about the 8-weeks of radiation.

[ron_bucher in reply to DLetterman]

My temporary side effect was lack of endurance. I could play doubles tennis for ~90 minutes with no problem, but playing 18 holes of golf riding in a cart was much tougher. The endurance came back not long after completion of treatments.

[DLetterman in reply to ron_bucher]

Thank you! I’m been working on my cardio and losing weight, so hopefully that will help. Mentally, thinking of 8-weeks of radiation has been taxing.

[Cooolone]

Well, there are a lot of questions that can be asked, most importantly is what relevance they have to YOUR diagnosis. I offer some thoughts...

First and foremost is what's your PSA Doubling Time? How is this related to your risk stratification? This will relate to timing for therapy application, meaning if it's not on a rocket trajectory, you may have time to explore not only 2nd opinion(s), but other therapy options as well.

Also, having a PSMA PET Scan at sub 0.5ng PSA isn't overly efficient. So it's quite possible there's something missed. Too many today believe the PSMA Pet scan to be some magical fail safe test, it's not, it has limitations. At 0.5ng the PSMA-PET Scan is still only like 60%+ efficient, at 0.8ng it's better than most scans at like 80%(+/-) in finding lesions. Remember too that those lesion sizes need to be larger than 4mm to be seen. So... With a low/slow PSA and low burden disease, you may be recurrent, but can't "see" what's causing it.

So oncologists will recommend salvage therapy that treats the Prostate Bed and surrounding Lymph Nodes, because it's easy and effective for most. Depending upon the diagnosis and risk stratification, it works for basically 2/3 of patients very well... Almost a 2nd shot at a "curative" treatment (used loosely).

So questions revolve around your diagnosis, have you don't the tests that help provide as accurate a diagnosis as possible. What other tests can be done, or is it worth even doing those tests? Then, based upon what is "seen" what therapies are available, SOC and cutting edge... Would something like MRIdian be available for YOUR treatment? Are you going to be on any systemic long term treatment as well (ADT) and if so, what? Mono-therapy or multi-modalities, multi-drug therapy?

Problem is everyone is DIFFERENT, and not all oncologists treat the patient as an individual. It is important to be risk stratified, but not thought of as just a simple member of a group. You need to ask the questions as they specifically apply to you.

Good Luck!

(edit) for typos

[NPfisherman in reply to Cooolone]

Agree with Cool,

Having a PSMA scan below 0.5 is unlikely to be useful... not sure why they did it at .12... Look at your PSADT, and have another scan at a later time when PSA is closer to .8... when I realized that my PSA was detectable again, I did not involve my MO at that point. I waited and got another PSA in 3 months... at that point, it was time to talk with him via messaging...

We waited until my PSA was above .5 to order the Pylarify scan which took 4 weeks or so, I estimate my PSA was about .75 or higher which showed one met... Got SBRT to the met and back on tx...

I would consider getting the Prostate MRI as discussed by LowT before doing radiation to the area.

All the best,

Fish

[treedown]

Hard to say what I would do in your situation, as mine is not even close, and I have now had so much radiation that it could hardly matter. I stopped worrying about 15-20 years in the future a long time ago. That said the actual radiation. 44 sessions was inconvenient at worst and otherwise a breeze.

[cujoe]

Missing from this discussions is:

1. Gleason score & age (already mentioned)

2. what was result of final biopsy, re; organ-confined, excap ext, seminal vesicle inv, lymph nodes - % of prostate cancerous, etc.

3. what was lowest PSA reading after surgery - unsuall done around 6 and 12 weeks out - to establish initial PSA nadir benchmark for rest of your treatment history.

That info would lend support to any advantage for RT.

[j-o-h-n]

Salvage Radiation

Greetings: bkatkins

Radiation - I've posted this before so to those people who have already seen this please forgive me.

I had 8 weeks of salvage radiation to "the bed". 5 days a week (not weekends) for 8 weeks minus 1 day for a total of 39 sessions at MSKcc. The actual radiation was like getting an x-ray by my dentist. I never had any side effects during the whole 39 sessions. However, 2 years later my left urinary tract was "fried" as per my urologist (or from passing prior kidney stones he was not sure). So, I had to have a urinary stent placed up my urinary tract (through my willy which is really nothing - sounds terrible but it's nothing) to aid in passing my urine (which was never a problem anyway). So I had stents in and out every three months for many years and now I'm stent free, However today 15% of urine from left kidney and 85% from right kidney, but not a problem. So make sure you get a good radiologist. Also, I don't know if this would apply to you but guys here recommend SPACEOAR HYDROGEL to be inserted for protection of parts of your body. Make sure you ask your R.O. about the spaceoar and make sure you ask here on this forum before getting fried.

j-o-h-n <===<<< Senior management is about to spike my spikes....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/16/2023 10:53 PM DST

[cujoe]

BK _ This is the document you should read in great detail before considering RT. It is updated every 5 years, so this is the current one:

Adjuvant and Salvage Radiotherapy after Prostatectomy: ASTRO/AUA Guideline (2019)

auanet.org/guidelines-and-q...

I found it by accident just before my post-surgery final-biopsy review with my surgeon back in 2013. It provided me the information I needed to decide to do Adjuvant IMRT and do it as early as possible.

Good luck - Ciao - K9

[MateoBeach]

You have BCR with no sign of distant metastasis. Radiation could give you a very good chance for cure. (Prostate bed and pelvic lymph node fields salvage radiation therapy). Talk to a good Radiation Oncologist. Your Urologist has no place in your management now. Without it your cancer will surely progress so in 10-20 years guess what?

[cujoe]

In addition the the AUAnet.org guideline, also listen very carefully to what MB is saying!