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Salvage RT. What can I expect.

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User
Posted 22 Nov 2021 at 09:02

Hi all, I'm due to have salvage RT soon as my psa has risen 0.2 29 months after robotic surgery. 


Op was in May 2018. 


Gleeson 3+3 upgraded to 3+4 post op.


T2c tumour N0 Mx and psa was 3.7


First psa 6 weeks after op was undetectable. Then after that 0.1 for 18 months. 


My consultant doesn't seem too concerned and is confident regarding the treatment. 


So just want to know what to expect in the way of side effects. 


I know everyone is different with this treatment. Thanks in advance. 

User
Posted 22 Nov 2021 at 15:51
Are you having just RT or HT as well? Most of the side-effects are from HT rather than RT. RT itself you're likely to suffer short term (weeks) urinary issues (needing to pee very frequently) and longer term (months) bowel disturbances. I found the whole process of RT quite bearable.

Best wishes,

Chris
User
Posted 22 Nov 2021 at 16:08
Has there been any consideration as to a PSMA scan to focus the RT?

I'm in a similar situation to you. RARP in Aug 2020, PSA post surgery was 0.04. It has steadily increased to 0.2. I had a PSMA ( Ga68) scan at the Royal Marsden which showed a lesion in one of my lymph nodes.

Started bicalutamide/Zoladex 6 weeks ago. No side effects ( yet) Fingers crossed that that will continue.
User
Posted 23 Nov 2021 at 12:00

I would certainly ask about having a PSMA PET scan first. It might mean waiting until the PSA is a bit higher first, to increase the chance of it finding the cancer. There's about a 50% chance on the newest scanners with a PSA of 0.2, and earlier PSMA PET scanners need a PSA of 0.5 for a 50% chance for finding the cancer.


Some trial data showed that the results of a PSMA PET scan changed the planned RT target area in 50% of cases of salvage radiotherapy. However, it's not normally done, particularly if your hospital doesn't have the capability in-house.

Edited by member 23 Nov 2021 at 12:01  | Reason: Not specified

User
Posted 23 Nov 2021 at 13:22
An interesting article on this subject:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935690/
User
Posted 29 Dec 2021 at 01:24

have had my appointment with the oncologist due to my psa rising from undetectable to 0.2 since my robotic surgery in May 2019. He recommended 20 sessions of salvage RT.


Due to my medical records showing IBS he is not keen for me to have RT and has referred me to have a colonoscopy to rule out IBS. Has anyone in this group had any experiences like this??


Psa 3.7 post op.


History: Gleeson 3+4. T2c N0 Mx


 


 

User
Posted 29 Dec 2021 at 20:24

I'm slightly puzzled by your post. In one sentence you say that your oncologist is recommending 20 fractions of RT, and then in the next that he is not keen for you to have RT. Why is he recommending something that he doesn't want you to have? 🧐 Perhaps you meant that he's not keen for you to have HT?


Cheers,


Chris

Edited by member 29 Dec 2021 at 20:29  | Reason: Not specified

User
Posted 29 Dec 2021 at 20:51
If he is concerned about the impact RT might have on your bowel, did he discuss with you the possibility of getting SpaceOar fitted?

Do you think that you have IBS or is it just that it has been queried in your notes at some point in the past?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 29 Dec 2021 at 23:21

The oncologist consultants only concern with me receiving 20 sessions of RT is that I have had a couple of IBS episodes on my medical records. To be honest, no I don't think I suffer from IBS it's probably down to eating something that didn't agree with me and took time to subside. I suppose that it is a condition that is over diagnosed so that is the reason why he's not happy on giving me RT as you can really have serious side effects if you suffer from a gastroenterology problem, that was his explanation, hence the referral to a gastrologist for investigation. 

User
Posted 30 Dec 2021 at 04:07
Okay - well, if the onco is still concerned after you have been seen by gastro team, s/he should be able to put you forward for SpaceOar which is a buffer inserted between the prostate and the bowel. SpaceOar may not be available at your particular hospital but still worth asking about.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 30 Dec 2021 at 11:06

Can SpaceOar be fitted in the absence of a prostate (this being SRT)?

User
Posted 30 Dec 2021 at 17:00
Yes it is possible and is done in America and Australia - the Royal Marsden was involved in a trial but my guess is that it is not widely available in the UK except in exceptional cases. It might be that IBS is enough of an exceptional situation to be accepted?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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