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Looking For Advice on Salvage radiotherapy

User
Posted 19 Sep 2021 at 02:09

Hello,

I was diagnosed with Prostate cancer in 2018. Gleason was 9, PSA 6.4

Was told by the urologist I had maybe 3 to 5 years before any tests were done - sweet fellow …

Had ct scan, MRI and bone scan - all negative.

Had radical prostatectomy - margins clear, no cancer in lymph nodes or seminal vesicles - was staged at TC3a as they found a bit of cancer outside the gland in the fatty tissue but margins were clear.

After 6 months, PSA was 0.2, so I decided to get an axumin pet scan - didn’t show much - maybe a small spot in prostate bed … had laser ablation in California to deal with it.

PSA was <0.1 for about a year … in early 2020 PSA started rising again. Went to Montreal for a Gallium pet scan … again, didn’t really show anything … MRI, CT Scan and bone scan all negative. Oncologist advised salvage radiation which I did in August/September of 2020, after a period of hormone therapy.

In early 2021 PSA rose to 0.2 then in a number of months 0.3 and now in September 0.9

When it was 0.3 my oncologist said not to worry, as the hormones were wearing off so a rise was expected - he said radiation can take a couple years to fully work, so don’t worry, as had I not taken ADT it would be higher at that point. So now, three months later, it’s 0.9 …. which is upsetting … although maybe as my testosterone is rising it’s just what happens - seems high though … I was at 1.1 in 2020 prior to radiotherapy and ADT.

Has anyone here had salvage radiotherapy?

Is what’s going on with me “normal”?

If you’ve followed a similar path I’d appreciate any feedback.

Cheers

User
Posted 19 Sep 2021 at 09:45
"Normal" in the UK would have been salvage RT as soon as you had the 0.2 after surgery as we don't have routine access to ablative salvage therapies.

I don't think a rise to 0.9 is normal and is worrisome.

I think I would be looking for another scan at 0.1 (now?) and confirm if they treated your lymph nodes when they did the SRT. Fingers crossed they can find a hot spot outside any previously treated area that can be ablated or irradiated.

User
Posted 19 Sep 2021 at 11:38
No definitely not normal; it sounds like your urologist and oncologist are rather optimistic souls. A PSA of 0.9 would be okay if you still had a prostate but anything over 0.2 post-prostatectomy indicates active cancer. Your PSA is also rising fast so less likely to just be a small remnant left in a pelvic lymph node; look up 'micromets'

Realistically, your treatment plan now will probably be more about a) long term management rather than cure b) deciding when to start hormone treatment to get the most effect for the longest time and c) whether early chemo or enzalutimide would be beneficial

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

User
Posted 19 Sep 2021 at 11:43

Over a seven year period neither surgery or salvage RT has eradicated my cancer. My PSA is now 0.73, normally my next step would be a scan at 2, 4 or even 8 to try and see if they can detect the source. My oncologist says PSA velocity is also a consideration when looking at scan timings. 

HT would be the next logical step for me. I do see guys mention the  possiblity of local RT depending on  what a scan may find.

My Gleason was lower than yours.

Thanks Chris

 

 
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