Rising PSA after RT - what next?

Thanks for your comments. Prepared a fairly long reply yesterday but crashed just before submitted. But essentially, I hadn't heard of 'Dose Painting' but on checking this it is being trialled at the Marsden and Clatterbridge. It seems to be another way of giving RT though and as I was told that I had received my full whack of RT - except a small amount for treating bone mets palliatively if needed - I am very doubtful whether I would qualify for it. I did ask the junior doctor at my consultation if Cyberknife was given as a salvage treatment for failed IMRT as somebody on the forum thought it might be. The doctor said she was not aware of this but said it was being trialled as a main treatment. Cyberknife is yet another way of giving RT, one of a growing number of ways. Whether one method is shown to be better overall or in particular circumstances only time will tell.

I think the way forward for me is to see what the Marsden say in their follow up letter to my GP. If they don't suggest a way forward, I will ask whether the doctors in Heidelberg think it is too early to have the 68 Gallium scan yet with my PSA history and most recent PSA level or at what point this scan might help show where the PSA was being generated so salvage treatment of one sort or another could be instigated.

We had a little chat in Leicester and I've just read your profile. Three things strike me. 1 your junior consultant doesn't seem to be completely on the ball. 2 you are aware that neither further RT or an RP are reasonable options. 3 you last had HT nearly 7 years ago.

Perhaps however reluctantly it is time to consider HT again. If I was in your place I would get a PSA figure settled in my mind, be it 2.0, 4.0 or whatever ( some oncologists are even saying 20.0 is a good starting place )and when that figure is reached go onto HT.

Having said that I'm not in your place so can't make decisions for you.

As always though I wish you well and it was good having that chat with you in June

Take care my friend

Life is for living

Barry ( alias Barrington )

Barry and Chris were both at Leicester, so will remember that I asked the guest Oncologist at that meeting at what point, after RT was shown to have failed (ie nadir + 2), further intervention should be considered. He said this was a grey area and it seems this may vary from one patient to another depending on the oncologist and the patient. However, to my simplistic way of thinking, if the the PSA is still coming only from the prostate, it would make sense to try other treatments to eradicate it there before it migrates. If the cancer is shown to have migrated already, then as Barry says, perhaps HT would be appropriate. I would have thought in this latter case it would be better to start the HT earlier rather than wait until it had taken a strong and maybe widespread hold. The question is at what point is a scan helpful to determine where the cancer cells are. With standard scans there can be difficulty in establishing this until the cancer cells become greater and give off more PSA (sometimes). But it may be that the more advanced Choline and 68 Gallium scans can determine where they are earlier and thereby enable appropriate treatment sooner.

Will keep you posted as I am sure there are others in a similar position.

I formed the same opinion as you Barry regarding my consultation with my very nice but inexperienced doctor. But to be fair she did say she would refer my case to a senior doctor. I shall have to see what is suggested but if a way forward is not offered, I will obtain the views of the doctors in Heidelberg on whether a 68 Gallium scan could be really useful at this point.