How long does SRT take to work? - salvage radiotherapy

Thought I'd lost this thread but re-found it! Anyway, any knowledge most welcome, thanks!

David

But Dave, such scans show nothing so low, I thought? Is the PET/MR you mention actually PET/MRI ?

Can't see any scans being offered on basis of current sort of level.

Whether or not your hospital is taking part in the research and/or whether your oncologist is aware of the trial outcomes, I guess, plus whether you are considered fit enough to take the higher dose?

They put John on the high dose regime because he was 52, still playing rugby, had been left with no continence issues post-op, etc. at that time, they were wanting to work out how high the dose can go before increased side effects start to outweigh the better outcomes in terms of remission. They seem to have settled at around 3Gy rather than the more traditional 2Gy although I seem to remember someone on here thinking they had been given 3.4Gy???

I suppose it would make sense not to offer salvage RT with a positive PSMA scan as remission is unlikely.

Yes, Lynn you are correct, I was really addressing the concern that David showed in a subsequent post regarding possible spread and taking another look at his numbers, a scan is probably a bit premature.

I hope David's PSA doesn't climb to that but it's worth keeping the scan option in mind if it does. No every onco seems to go for it, I had to press mine when my PSA was 0.6

Hi Guys,

Perhaps I am thick, but one thing I have never properly understood is how much PSA a healthy man should have?

As I understood it PSA should be contained within the prostate, but as we get older and the prostate expands either through cancer or benign expansion the structure of the prostate gets a little distorted and PSA leaks out.  I have thought of it like a car engine, when it is new all the oil stays inside, as it gets older, with worn bearings and gaskets some oil starts to leak?

So a man in his sixties, with no symptoms of PCa and a PSA level of 3 or even 4 is considered healthy?  I wonder what PSA level is found in a healthy man in his 20's or 30's?

A decent size tumour will give quite a high PSA level, mine was 30 at diagnosis and the PCa was still contained within the gland, guys whose PCa has metastasised often have a PSA level in the hundreds.

So for men who have had RP, which has left some healthy prostate tissue at the margins are likely to have some PSA produced by those healthy cells.  In the same way they go to a lot of trouble with EBRT to focus the beams on the cancer, and ditto with Brachytherapy they use the template biopsy to determine where to place the rods, they don't simply irradiate the entire prostate gland.

So whatever treatment we have had we should all be left with a few healthy bits and pieces of prostate that might be expected to produce some PSA.

So why do the doctors get concerned about such low levels of PSA?

:)

Dave 

Have you not read my latest post on my own thread? The ultra sensitive test is now apparently being discredited - our hospital trust (which is one of the centres of excellence for cancer) has stopped all ultrasensitive PSA testing for the region.

I think your post is a bit muddled about your scores. If you had gone from 0.04 to 0.2 or 0.3 that quickly you would be in deep doo-dah. I take it you are only guessing it might have done that and no-one has actually told you that was the case?

Lyn, Interesting about the sensitive tests. In that case, I have not yet had a recurrence, but have had RT. But I think it was clear something was going on, so best I got it done.

Sounds like 9 weeks post RT is too soon to get a drop showing, is that what I'm inferring? I must say, others on here have been told to wait 6 months before a first test post RT...one or two PC UK nurses also thought it was a bit early...

Thanks

david

I agree with you. My oncologist recommended follow up RT when my PSA reached 0.087. Obviously she had the histology following the RP. According to google and this site I had not had a recuurance but I certainly was not going to go against her advice

Bri

I'm just worried that the excellent drop to 0.03 has now been followed 3 months later by this 0.05. I can't help feeling that it should have gone down, if cells are still dying, rather than up. Why should it fluctuate up, if the RT is still working? I can't help feeling there's a bit it missed. But maybe I'm still in shock, and this test is too sensitive, as you have implied.

David

Yes I think you are going to continue torturing yourself whatever any of us say. You were advised to have nerve sparing on only one side but you went against that advice and chose a surgeon who saved both sides. In the event, it seems the previous specialists may have been correct and I imagine that your oncologist took that into consideration when designing your RT, to ensure that the nerve bundles at that side were well and truly zapped. That being the case, you are trying to read something into tiny fluctuations in a PSA level which is similar to an average woman that has just had an orgasm. There is a possibility that you have had unnecessary salvage treatment based on a flawed test but you will never know for sure.

I can say the same things that I have said before but I don't think it will help you if you have decided to see the worst possible interpretation:
- scientists have shown that if you put the same blood sample in the same machine twice, the result can vary by as much as 0.04
- the testing equipment is calibrated at least every 6 months which can affect results and therefore how you interpret PSA trends
- a variation of 2 hundredths is tiny and could simply be down to a bit more adrenaline (perhaps due to anxiety?) at the most recent test
- sometimes dying cancer cells produce extra PSA which is why the PSA test at 18 months post RT is considered to be the important one

On holiday in Malta for a few days, nice but of course but guess what is in my head all the time!
Maybe hypnosis would help....

I know the official line of undetectable is 0.1 but of course the point of the sensitive test is to detect anything actually present below that. Actually my RT consultant said that, unlike surgery, RT usually does not take psa down to their lowest possible reading - <0.02. And he said they don't know why that is the case, but it may just settle somewhere a bit higher than that....0.0 something.....?

Unless you have made a mistake typing in the results, it seems that you are now detectable and will need to decide with your onco at what point you start hormones again. Some onco say to wait until it gets to 5 or 10 - Bri’s onco likes to wait until it gets to 20 and my dad has decided to wait until at least 10 and then think again at that point.

Not what you were hoping for but the fact that it goes up and down suggests it isn’t particularly aggressive.

Just check that you haven’t missed a 0 out of each result though.

Hi following salvage therapy in AUG 16  my first two PSA test.  in JAN  17 and JULY 17 where undetectable <0.1. Then a rise in DEC  17 too  0.1 and feb 18 again 0.1 very disappointed I saw the urologist who said it looks like salvage therapy may not have  been successful. I have been advised that it may take many years before further treatment is required saying that a PSA of 20 would be the indicator for HT etc. Now advised to continue PSA tests every 3 months with the doubling time being an important factor to watch for. I have tried to defeat this beast and I am trying to stay positive for the future. When I see other men on this site bravely facing much worse diagnosis I still consider myself fortunate. I hope this post helps  Andrew

That makes more sense.

A PSA of 0.11 is detectable though so there is no point continuing with the ultra sensitive tests. John was 0.11 at one point last year and although it has dropped back to <0.1 we have accepted that SRT didn’t eradicate it completely and HT will be needed at some point in the future.

I started my SRT 3 years post RARP at a PSA of 0.27, 3 months post SRT it was 0.08, at 6 months it was 0.04.

Next test tomorrow. I did not have HT.

Thanks Chris

With regards to the sensitive testing, what I have to say may risk some criticism. My oncologist is convinced of the benefits of the sensitive test. I went from 0.014 to 0.023 over the space of the year post prostatectomy. In another hospital, I may have been told that my PSA was less than 0.1 and therefore undetectable. My onco said my PSA was persistent and indicated salvage radiotherapy was needed. But she also recommended a PSMA scan and cells showed up in two lymph nodes. I don't know enough about the data regarding the sensitive PSA tests, but based on my experience, I'm happy with them.

Finally, I asked her what PSA level she would look for post salvage radiotherapy- she said 0.003. That's low.

Ulsterman

Thanks Lyn.

It's useful knowing John had similar stats here. Is it also not relevant now that, 14 months after SRT some cancer cells are still dying and producing more PSA, something you said a previous time? Also, something I will ask my onco, I had 22 nodes removed, all ok, and the bed got RT....so where could any cancer cells now still be growing ...absolutely anywherein the body? ie. they escaped pre SRT....or just survived the SRT? And does this mean, officially, I have metastasis?

Thanks very much

David

Lyn after today's bad result (a jump up from 0.05 to full fat 0.11) after a steady year where I was beginning to have some confidence, I REALLY needed someone to give me some hope. I know I'm not on the edge of death, but I DO know that if it hasn't all been got, it will rise and rise. And I know HT does not work for ever. I'm 57 so.....

YOU, with that sentence above, have given me some hope! With my cancer diagnosed unexpectedly, supposedly sorted by RP, failed so SRT, looking dubious, I'm pretty down.

It may be dashed in 3 months' time when I will be at 18 months post SRT ending. I realise that. I do still wonder though why it's gone up now at 14 months when it was pretty steady, but there we are....

THANK YOU!

But I just recalled earlier you said: 

it seems that you are now detectable and will need to decide with your onco at what point you start hormones again.

That's a bit different to not panicking!!

Edited by member 27 Feb 2018 at 20:12  | Reason: Not specified