recurrence after radical prostatectomy

There are small number of oncos who seem to feel that HT is unnecessary with salvage RT but the vast majority will recommend somewhere between 6 months and 2 years of hormones.

With the exception of Ulsterman, biochemical recurrence after surgery is defined in the UK as a PSA over 0.2 or three successive rises above 0.1 so you are not quite there yet but I would certainly want to be on the onco's books now rather than in May / June.

I agree with Lyn in that this is behaving like a local recurrence.

I had a Gadolinium enhanced MRI and an F18 Choline PET scan which both showed up where any local recurrence was and allowed the oncologist to plan the salvage RT beams more precisely.

If I were you I would be looking to see an uro oncologist to discuss this.

My recurrence was high risk so i have had three months HT before SRT followed by 2 years of HT but in your case it might be no HT or HT for a few months before SRT.  The oncologst will decide that based on your individual situation.

Let us know how you get on at your appointment.

Best wishes.

I see you have not yet discussed this slowly progressing cancer with an oncologist. I would.

It seems your surgeon did a good job in 2015 and is unlikely to be of very much more use to you in the future.

Best of luck anyway.

Cheers, John.

Edited by member 03 Mar 2019 at 12:10  | Reason: Not specified

All the research is that the sooner you get salvage RT the better your chance of achieving remission. If you were my man, we would be seeing the onco now.

Morning Clive, I had my RP July 2015 and the post op psa tests rose uniformly, 0.02/0.04/0.06/0.08 and it was at this point that my urologist who did the op said that if the next test was 0.1 or above I would be referred to the oncologist with a view to having SRT. It did indeed go up to 0.12. The Oncologist stated that early intervention was favourable for a cure. I had the SRT in Feb/March 2018. I agree with the other posts that recommend pursuing this further. All the best mate, take care. Paul.

Clive, the bicalutimide will probably be just for 2 or 4 weeks; you should ask him the next time you see him how long he plans on you having the Prostap for ... oncos can plump for anything from 6 to 36 months. There is absolutely no doubt that HT with the RT provides a much better chance of success, particularly if you have the HT for at least 3-6 months before the RT begins. However, recent data suggests that there is no additional benefit from extending it beyond 18 months.

With a slowly increasing PSA you have classic signs of stray cells left in the prostate bed, which is where the RT will be designed to target anyway. They will also use data from your post-op pathology to predict where the stray cells might be, if the pathology had raised any potential issues.

Edited by member 23 Nov 2019 at 14:41  | Reason: Not specified

They both had recurrence, and had umpteen fractions of RT and their PSA is now undetectable. One told me he has erectile dysfunction like me, the other? I didn't think it was appropriate to ask him by text.

Another friend (they come out of the woodwork don’t they?) aged 63, has just had surgery in September, but his PSA is 0.2 post op, and he is still in nappies.

His wife has told him not to bother with any further treatment to which I replied ‘Why, is she looking at a big life insurance payout when you croak after a long, lingering, painful, demise?’

So I hope, with the testimony of my two other mates - who don’t know each other - to persuade him to go for adjuvant radiotherapy.

Cheers, John.

My PSA rose steadily to 0.10 (two years post-op), just started bicalutamide and will have SRT probably January or so. Bicalutamide doesn't seem to affect me very much so I'll likely take the full two year course. It significantly improves the effectiveness of SRT. Had a PSMA-PET scan which didn't show anything, my understanding is that it is unlikely to show anything, but if it does it can be hugely important, so worth taking. (See http://jnm.snmjournals.org/content/59/5/789.full.pdf)

Note the Tendulkar et al study (http://riskcalc.org/ProstateCancerAfterRadicalProstatectomyNew/) suggests it is slightly better to have SRT earlier, say around 0.10, rather than later. I understand currently SRT is likely to have better results than suggested by the Tendulkar study, because with today's better PSA measurements and PSMA-PET scans incurable cases that would have got SRT before won't get it now. Also SRT techniques probably improved. 

Edited by member 24 Nov 2019 at 20:01  | Reason: Not specified