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Salvage radiation failed, what next?

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User
Posted 06 Dec 2021 at 12:25

Hi all,

Not the best days lately to have experienced that PSA has increased to 0.45 after 3 months of salvage radiation being over https://assets.hu-production.be/aurora/images/smiley/sad.gif

So a bit of a background: After RP in April 2018, PSA went up slowly but steady till 0.25 in June 2021, then I had radiation on July and August 2021 for 33 session - 66 GY - on prostate bed as well as lymph nodes in the pelvic area.

3 months after RT PSA went up further to 0.45 on the first follow up check.

What is next in anyone's view?

My doctor is wanting me to do another PSA test in January, if it raises further and beyond 0.5, which she believes it will, I should do another pet exam. If anything spotted there eligible for radiation, they will do radiation to that (those) spot(s), but I will go for hormone treatment as well. She said going now for hormone treatment without any body check may mean we lose track of anything that could be still locally treated first with radiation. Does this make sense to you? For me it did ...

Thanks in advance for your comments,

Paulo

User
Posted 06 Dec 2021 at 12:51

Hi Paulo, sorry to hear things aren't going well. The plan from the onco makes perfect sense. The assumption the cells were in the prostate bed was a reasonable assumption but it turns out to be wrong.

So there are some cancer cells elsewhere in your body. Hopefully they will show up on a PSMA pet scan, and be confined to a small area which can be blasted.

Dave

User
Posted 06 Dec 2021 at 13:09

Yes, I agree that's a good plan. You ideally want a PSMA PET scan before you start on hormones, as the hormones will make the scan less sensitive.

User
Posted 06 Dec 2021 at 17:04

Paulo

Now 4 years post salvage RT, my last three PSA results were 0.86 ,1.0 and now 0.99.  I had a CT and Bone scan as part of a trial a month ago, nothing significant showed up. I saw my oncologist last week he is still sticking to waiting for  a more sensitive scan at 3 or 5. Similar RT treatment plan to yours if something found. 

Thanks Chris 

 

 

Edited by member 06 Dec 2021 at 17:06  | Reason: Not specified

User
Posted 06 Dec 2021 at 22:47
Chris why not PSMA PET now??

Paulo I think your consultant is correct with their approach, is there any chance that it's too soon to be sure the RT has failed? What about the RT causing cell death and additional PSA release?

User
Posted 07 Dec 2021 at 08:01

Paulo 

I do seem to have some erratic  readings, the full list is in my profile. The rise between 0.86 and 1 was only 26 days and was the fastest rate if rise so far. When I questioned my oncologist about reliability of testing he said the machines are okay, its the patient's blood sample that is unreliable.

 My oncologist did also say SRT to the prostate bed was "a very educated guess based on years of experience".  My PSA did drop after SRT then rise again which would suggest that something was in the bed.  Looking at your profile the SRT has not had an effect on your PSA.

Hope you get some answers.

Thanks Chris

 

User
Posted 07 Dec 2021 at 16:30

Hi Paulo,

I think your onco is being good to treat those local spots.  Shrinking them with Hormones before a scan doesn't seem a good idea, although as others have said a PSMA scan would likely be better but I'm not sure how available they are.  They're also being good giving you frequent psa tests. 

All the best, Peter

 

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User
Posted 06 Dec 2021 at 12:51

Hi Paulo, sorry to hear things aren't going well. The plan from the onco makes perfect sense. The assumption the cells were in the prostate bed was a reasonable assumption but it turns out to be wrong.

So there are some cancer cells elsewhere in your body. Hopefully they will show up on a PSMA pet scan, and be confined to a small area which can be blasted.

Dave

User
Posted 06 Dec 2021 at 13:09

Yes, I agree that's a good plan. You ideally want a PSMA PET scan before you start on hormones, as the hormones will make the scan less sensitive.

User
Posted 06 Dec 2021 at 13:22
Thanks a lot Andy and Dave for your feedback.

The problem is the waiting and keeping my mind busy with other stuff. I have to handle it for sure.

User
Posted 06 Dec 2021 at 17:04

Paulo

Now 4 years post salvage RT, my last three PSA results were 0.86 ,1.0 and now 0.99.  I had a CT and Bone scan as part of a trial a month ago, nothing significant showed up. I saw my oncologist last week he is still sticking to waiting for  a more sensitive scan at 3 or 5. Similar RT treatment plan to yours if something found. 

Thanks Chris 

 

 

Edited by member 06 Dec 2021 at 17:06  | Reason: Not specified

User
Posted 06 Dec 2021 at 22:47
Chris why not PSMA PET now??

Paulo I think your consultant is correct with their approach, is there any chance that it's too soon to be sure the RT has failed? What about the RT causing cell death and additional PSA release?

User
Posted 06 Dec 2021 at 23:07
Thanks Chris for your message.

Your PSA levels don't appear to be increasing, do they?

User
Posted 06 Dec 2021 at 23:14
Thanks Jonathan for your message.

My doctor told me that as I don't have a prostate, PSA numbers shouldn't increase that much, even if some cells are left in the prostate bed. I have read about your comments before somehow somewhere (death of cells increasing PSA) and wished this could be the case for me. Anyway I am having a PSA test later in December and see how it will go in just 1 month and repeat it in January ... More information won't hurt, right?

She said that the odds of a PET scan showing up something higher than 0.5 becomes much greater and thus she expects to see something to treat!

User
Posted 07 Dec 2021 at 08:01

Paulo 

I do seem to have some erratic  readings, the full list is in my profile. The rise between 0.86 and 1 was only 26 days and was the fastest rate if rise so far. When I questioned my oncologist about reliability of testing he said the machines are okay, its the patient's blood sample that is unreliable.

 My oncologist did also say SRT to the prostate bed was "a very educated guess based on years of experience".  My PSA did drop after SRT then rise again which would suggest that something was in the bed.  Looking at your profile the SRT has not had an effect on your PSA.

Hope you get some answers.

Thanks Chris

 

User
Posted 07 Dec 2021 at 08:08

Originally Posted by: Online Community Member
Chris why not PSMA PET now??

Franci 

I do keep asking that question and he believes at that the 3 or 5 would give a better chance of picking something up. 

Thanks Chris

 

User
Posted 07 Dec 2021 at 16:30

Hi Paulo,

I think your onco is being good to treat those local spots.  Shrinking them with Hormones before a scan doesn't seem a good idea, although as others have said a PSMA scan would likely be better but I'm not sure how available they are.  They're also being good giving you frequent psa tests. 

All the best, Peter

 

User
Posted 07 Dec 2021 at 16:35
Hi Peter,

Thanks for your message.

Yes it will be a PSMA Galio 68 scan.

I am also doing PSA tests now 1 every month, even at my expenses, but no bother with that.

 
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