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Salvage Radiotherapy at PSA 0.13

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User
Posted 07 Jul 2020 at 15:48

I had a Radical Prostatectomy in October 2016 at age 64.

I have no problems with incontinence or erectile dysfunction.

My PSA was undetectable for over a year but then rose slowly to (currently) 0.13.

PSA doubling time is over one year. Gleason score was 3+4 = 7.

My oncologist now recommends 6 months hormone treatment – Bicalutamide tablets – coupled with 4 weeks radiotherapy. I assume this is appropriate though I believe the European Urological Association regards PSA doubling time below a year and Gleason below 8 as at a small risk of metastatic progression.

I’d appreciate any comments and advice and particularly with regard to side effects of these two treatments.

Thanks, Aimable

User
Posted 07 Jul 2020 at 16:29

Hello Aimable, it sounds like with your long PSADT and nearly 4 years from surgery that the chances are this is a local recurrence.

I had a recurrence a year after surgery in July 2015 but my PSADT was 1.2 months. My PSA jumped to 0.3 them quickly progressed to 0.7 within a couple of months.

I have found that the salvage radiotherapy has left me less continent than I was but solifenacin seems to reduce the bladder spasms and I do not use pads. I have radiation proctitis too which at time is unpleasant. 
I would think you have a good shot at long term disease control with the SRT. 
Have a read at my profile if it helps.

Best wishes, 

Ido4

User
Posted 07 Jul 2020 at 23:02

How many guys are getting the PSMA  type scans before salvage RT ?

Thanks Chris

 

User
Posted 07 Jul 2020 at 23:13

I agree with Ido - my husband had salvage RT 8 years ago following a biochemical recurrence although in his case, the PSA reached 0.16 in 2 years so your rise is significantly slower. 8 years on, his PSA remains stable around 0.1 so the Onco's view that the recurrence was in the prostate bed looks to have been correct. As Ido says, a low post-op PSA followed by a slow steady rise is classic for some stray cells being left behind in the prostate bed.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 07 Jul 2020 at 23:15

Originally Posted by: Online Community Member

How many guys are getting the PSMA  type scans before salvage RT ?

Thanks Chris

 

 

My guess is that if the man is presenting with classic biochemical recurrence, many oncos will consider the PSMA scan as an unnecessary delay & expense. Its value is more in relation to cases of high first post-op PSA test and / or rapid rises where there is less likelihood of it just being a few stray cells in the prostate bed? 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 08 Jul 2020 at 08:27
I have just had my 5 year checkup with my urologist, PSA was <0.1 I couldn't get a supersensitive test like normal because of Covid and because of my new found confidence I have decided to stick with the standard test going forward.

So I asked the urologist "What if" my PSA is still creeping up and next year it's >0.1?? His answer was unequivocal that PET PSMA would be generally available by next year in the Midlands and that should be my first choice.

Unfortunately research on salvage RT timing still seems all over the place with some saying go as early as 0.03 (which would have caught me) and the latest research saying there is no rush.

At 68 if you are continent, potent and enjoying life I would think twice about salvage RT at least until you have had a PET scan.

User
Posted 08 Jul 2020 at 09:18
Following a recent rise from undetectable to .02 I've been told that if it gets to 0 .1 the next step will be MRI scan and EBRT. When I asked about PET PMSA I was told MRI is just as good. I will challenge it if it happens as I believe cost and local availablity is involved in the decision.

Someone posted a list of scans and comparison of success in finding tumors at different PSA levels a while ago but I can't find it. Anyone else remember?

Cheers

Bill

User
Posted 09 Jul 2020 at 15:44

Thanks so much for all these replies.

francij1 do you have a link to latest research saying no rush for salvage RT?

What is the significance of PSMA PET scan before RT decision please?

User
Posted 09 Jul 2020 at 15:50
If the PET scan shows spread to other areas of the body , then the RT won’t be curative and you need to decide whether worth it on that basis
User
Posted 09 Jul 2020 at 17:46

Originally Posted by: Online Community Member

Someone posted a list of scans and comparison of success in finding tumors at different PSA levels a while ago but I can't find it. Anyone else remember?

Not sure if this is what you where thinking of, but I posted this article a couple of months ago that looks specifically at PSMA PET with different radio tracers.  The blog article is already a few years old.   The most sensitive at present is the 18-DCFPyL tracer, which is currently only available as part of clinical trials in the US and Canada. 

https://pcnrv.blogspot.com/search/label/PET%2FMRI

 

 

User
Posted 09 Jul 2020 at 22:48
User
Posted 10 Jul 2020 at 10:40

Originally Posted by: Online Community Member


Someone posted a list of scans and comparison of success in finding tumors at different PSA levels a while ago but I can't find it. Anyone else remember?

Cheers
Bill

 

Thanks janus381 and frankij1 both links are interesting and useful but I was looking for a post that just listed the types of scans and their success rate during trials in finding PCA at certain levels of PSA. It was about two or three months back. No links just a list written on the post.

Cheers

Bill

 

 
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