Is radiation therapy warranted - Prostate Cancer N...

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Is radiation therapy warranted

Downhill_Skier profile image

I had a radical prostatectomy in June 2019 at age 52. Final pathology report: Gleason 7 (3+4); Extraprostatic extension; negative margins; Primary tumor: pT3a; regional lymph nodes: pN0.

My PSA 90 days post-surgery was .008.

PSA rose to .016 by December 2019 and in March 2020 it was .015.

Latest PSA as of Sept 2020 is .035

Although not an official bio-chemical recurrence, I have no doubt my PSA will continue to rise and that I will ultimately need radiation or some other treatment.

COVID has dramatically scaled back my work travel schedule. Starting radiation in 30-45 days would be least disruptive work wise. Not getting radiation may ultimately be the most disruptive, permanently.

Would appreciate any feedback about waiting longer or starting radiation in 3-4 weeks.

12 Replies

You should have at least 3 PSA increases over 0.03 or reach 0.1 before salvage radiation.

Is there a website you recommend that does a good job of explaining parameters of when or whether to start salvage radiation?

Try this:

I appreciate the various comments to my original post, but what I’ve read in the literature that Allen recommended is pointing me in the direction of getting started on radiation sooner rather than later. For example, the UCLA study by Kang et al. found that an ultra-sensitive PSA greater than or equal to .03 ng/ml is “the most important and reliable predictor of BCR .... (and) that only 2% would be over-treated by waiting for this cut-off” in RP patients whose post-op pathology report showed stage PT3-4 disease and/or positive surgical margins. In my case, the potential benefits of early salvage radiation therapy outweigh the risks. The purpose of this post is certainly not to be argumentative or ungrateful for the feedback I’ve already received. Rather, I would appreciate anyone having another go at telling me why someone with my post-op pathology report (pT3a, extraprostatic extension and (3+4) Gleason plus a rising PSA should not start early salvage radiation therapy.

Keep in mind that the Kang study was retrospective, while RADICALS-RT was a randomized clinical trial. So RADICAL-RT is a higher level of evidence that trumps the observational study. Observational studies are plagued by selection bias. Also, note the dates. RADICALS doesn't say it's a bad idea to get treated earlier - it didn't look at that - it just tells you that you lose nothing by waiting for the later benchmarks.

Thank you.

I will look more carefully at the Radicals data.

I had Gleason 3+4 = 7 Prostate Cancer with RP in May of 2019 with microscopic EPE, microscopic pos Surgical Margins, neg lymph nodes, neg extension to the seminal vessicles & no mets on Axumin scan. 90 days aft RP I started Adjunctive RT. During RT I trained for an Ironman Triathlon (2.4 mile swim + 112 mile bike + 26.2 mile run) which I completed about a month after RT finished. My RO is a big believer in the idea of having a goal during RT. He believes those who have a goal during RT seem less likely to suffer RT complications. The last few weeks before RT ended I would tend to get tired more easily and I was sleeping more. RT was completed in Oct. of 2019. So far PSA tests are going well ..... my MO said he would not recommend any add'l treatment unless I reach a PSA of 0.1. Submitters on this site have made me aware some supplements interfere with PSA readings and I suspend supplements 4-5 days before a blood test (now every 12 weeks).

My Doc says the following "We are hoping for a PSA <0.1 ng/ml.

If the PSA is not that or starts rising we can consider radiation therapy, and we can discuss all this at a 3 mo appt in person or by phone/telemedicine as you prefer"

Murk profile image
Murk in reply to Murk

BTW, he is a leading Urologist at John Hopkins in Baltimore.

Robert Redford would say wait!!!

I would wait as TA suggests. My diagnosis was very similar to yours Gleason 7 and T3a tumour. I had RP over a year ago and, apart from my first PSA reading of .002, my PSA rose over the next year to .2 . I had a CT scan which didn’t pick anything up and I am just about to complete my SRT alongside hormone treatment and hoping for a cure. The side effects have built up over the time, exhaustion, incontinence, hot flushes etc, but bearable. You can find more in my posts. Best of luck with it all!

Did you get a Decipher test? Maybe that will help make your decision.

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