My husband was diagnosed in Aug. 2020. Biopsy showed Gleason 9 with 3 cores positive. He had hormone therapy shots for 3 months, then a prostatectomy in Feb. 2021. Now his PSA has risen to .4 so he was put on hormone therapy (Orgovyx) and they want to start radiation. It is called biochemical recurrence. PSMA scan, CT scan and bone scan came back negative, so we don’t know for certain where the cancer is. Radiation will cover the entire pelvic cavity. Just wondering if anyone else has a similar diagnosis/situation. We aren’t sure he should start radiation without them knowing for certain where the cancer is. Two radiation oncologists (Vanderbilt & MD Anderson) both agree he needs to start 8 weeks of radiation to the pelvic area. Anyone have any thoughts on this? Should we seek another opinion? Does it make sense to do radiation to an area because statistics show it is most likely still in the pelvic cavity Wondering if he should wait for his PSA to rise more and get a new scan to try and pinpoint the cancer. Then he might be eligible for Proton Radiation Therapy which is less damaging to further organs since it is more targeted therapy. Any advice or insight is appreciated. Thank you.
Biochemical Recurrence: Radiation - Prostate Cancer N...
Biochemical Recurrence: Radiation
Although I am not one of them, there are many here in HU who have a similar situation to that of your husband.
I am glad your husband is on Orgovyx now, and the advice you are getting from RO consultation makes perfect sense to me from the perspective of earliest intervention in hopes to avert systemic treatments later on. I do not believe waiting is what I would do.
Waiting to target individual tumors is not curative, only palliative and your husband is not at that stage so whole pelvic radiation makes sense from my understanding if nothing is showing on a PSMA scan.
I am unaware of any evidence that proton therapy is any more curative than photon therapy.
The worst thing you could possibly do is wait for his PSA to rise just so you can see some of it. We know how prostate cancer travels when it leaves the prostate. You have to treat what you can't see, even if you could see some of it.
There is no evidence that proton therapy is less damaging to other organs vs photon therapy.
Thank you for your input. Makes sense.
You wrote that "his PSA has risen to 0.4". Did you strip-off any further digits? If not, he got the wrong test. After RP, PSA tests should have an _at least_ precision to 2 decimal digits. Ultrasensitive 3 decimal digit precision is even better. The reason for this is to be able to establish a more solid doubling time (PSADT). The latter is an indication of the aggressiveness of the cancer. In calculus 3 points in time are enough for deriving this, but if other factors are accounted in, like measurement noise and deviation from an exact exponential function, 5-6 points in time are mandatory for a good estimation of the doubling time. Your husband had his RP a year ago, so, if typical quarterly tests were followed, he should have by now 4 points in time.
BUT, the first and probably the second were skewed by the hormone therapy he had before RP and should be discarded. Summing this up, you are in a position needing to make a decision based on very poor info. An isolated PSA figure says almost nothing (I have written this phrase a myriad of times here in the past).
I am a retired engineer and always try to translate the numbers to their real value.
Will give you a parallel: You want to buy a new car. Here in Europe taxation follows the total cylindrical volume. It is good for car registry but says nothing for the car itself (think of Gleason Score here). Then there is the horsepower of the engine. It starts to give some more info on the specific car, but ... it all depends on the weight of it. By itself it says almost nothing (think PSA here). Finally, the number that draws up a more comprehensive image of the car's capabilities is the 0-100km/h acceleration time (think PSADT here).
Thank you for your reply. I attached a picture of his lab results from MD Anderson.
Labs not showing. .
Lab results from MD Anderson
MDA also reported mine as 0.3, 0.4, and 0.5. How do you like Dr. Tang? My MO Dr. Tu is no longer there. Might have retired. By the way, my case is similar but 4+3 no Mets on scans and I just finished 35 salvage radiation sessions with ADT.
Glad to hear you had no Mets and you are finished with your radiation sessions! We like Dr. Tang pretty well, but he is so busy his assistant handles most everything and then he pops in the last 10 minutes to ask if you have any further questions that his assistant didn’t answer. MD Anderson is such a large hospital. You are asked what is your number rather than what is your name. Dr. Tang wants my husband in a trial of 5 weeks of salvage radiation instead of 8. My husband is concerned 25 treatments may not get it all. He’s mostly concerned about getting lymphedema from the radiation since they already removed 16 lymph nodes during RP and will be radiating two major pelvic lymph nodes. He was told it is a possible side effect. He had a lot of lymphatic fluid drainage after RP so his drain had to stay in for 3 weeks.
Typical test for UNTREATED men. I was under the impression that MD Anderson is a top-notch institution. After this gross mistake I am reconsidering.
MD Anderson shows .3 and Vanderbilt (Nashville, TN) showed 0.20.
Vanderbilt PSA lab results
Vanderbilt's 0.20 can be anything between 0.195 and 0.2049, while MA Anderson's 0.3 anything between 0.25 and 0.349, a 10fold wider margin. In measurements this ambiguity is called quantisation or rounding error. The more significant digits the smaller this error.
They also don't specify which assay they used so could be different ones which examined the difference. Thats why some recommend using the same labs, at least for decision making. I agree with Justfor And would think they should be using ultra sensitive tests after RP.
would you be happy if results were to 2 decimal points? I'm not convinced that the guidelines for doubling time are precisely accurate for deciding on anything anyway !! Like most things of this nature, more likely a ballpark number based on hopefully a number of studies. anyway for RP, isn't the guideline more like 3 consecutive rises?? or only a doubling time ?
Guidelines my foot! Three consecutive rises at what time intervals? A day, a week, a month, 3months, 6months, a year, a decade? Dropping numbers at random just to impress and look well vested is in the politicians's agenta. Applied sciences professionals want to know exactly what each number represents. Medical doctors are wandering somewhere in between.
Similar situation for us as Dave had RP July 2020, 3+4, post op bloods were 0.03 until Jan 2022 0.05, Feb 0.07….. being told numbers are low and to wait. We are in Ireland and soon as we get 3rd rise which is imminent I’ll start pushing. Get cracking with your hubby’s next line of defence. Keep in touch and best wishes. Vicky
0.03 APS μg/L post-RP already show that there are still Prostate Cancer Cells.I still have my prostate gland and since 2020/09/15 my PSA fluctuated from <0.01 to 0.03 APS μg/L n March 09, 2022. My last Lupron Depot 45mg/26 weeks was on May 31st 2020.
I whish you and David good luck, from the other side of the ocean.
Hey Emily. We also see Dr. Tang and had the same issue. RP and then a year later rising PSA. Husband opted for 35 treatments of radiation at MDA to the prostate bed only. His Gleason was 7 however he did have an EPE. We did a phone consult with UCLA as well and they recommended the same: immediate radiation. From everything I've read it isn't good to wait until the tumor becomes visible on scan.
Thank you for sharing. When did your husband have the radiation treatments? Did he have many side effects from the treatments? During/after? My husband is worried about developing lymphedema since they will be radiating the two main lymph nodes after already having 16 lymph nodes removed when he had the RP surgery.
How is your hubby doing at the moment?We are heading down the same path in think.
Psa rising after Rp july 2020.
while local radiotherapy in the absence of structural disease may give good response to biochemical recurrence, there is still inadequate data on whether it changes the overall outcome. Recent studies have shown that while rise in PSA almost always precedes structural recurrence, often by many years, the cause for the biochemical failure may be outside the pelvis and hence the merits of blindly irradiating the pelvis have to be weighed against the risk stratification of the prostate cancer, the morbidity of the radiation and the patient's need to preserve sexual and urinary function.
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