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Salvage treatment.

Posted 18 Nov 2022 at 10:22

Extract from link.

The optimal timing to initiate salvage radiation therapy after prostatectomy is unclear. This study evaluated the outcomes of salvage radiation therapy initiated at a PSA level ≤0.5 ng/mL in patients with biochemically recurrent prostate cancer. The study included 397 patients, with 45.8% of the patients receiving treatment when their pre–radiation therapy PSA levels were ≤0.5 ng/mL. They found that pre–radiation therapy PSA level was the most significant predictor of biochemical recurrence–free survival and metastasis-free survival outcomes. In addition to PSA levels, seminal vesicle invasion was predictive of metastatic disease.


This study involving patients with biochemical recurrence of prostate cancer following radical prostatectomy found that early initiation of salvage radiotherapy at a PSA level ≤0.5 ng/mL was predictive of better oncologic outcomes.




Thanks Chris 


Posted 19 Nov 2022 at 22:20

Thanks Chris,  That study says having SRT below 0.2 doesn't improve matters unless you have 2 high risk factors, although it says it hasn't fully analysed that. 

I think I'd prefer SRT around 0.2 after having a psma scan and then having a course of hormones to get the psa down to under 0.1.  Then having hormones again after the SRT.   My Gleason was 4+4 which is one high risk factor. 

A nomogram from a bigger sample says having  SRT and hormones improves your chances significantly in my case.    Some have said it would as you're on the hormones longer but the upper limit is a lot longer than that.  That's my opinion at this moment although I'm all ears, as they say.   Peter

Posted 19 Nov 2022 at 23:11

Peter, it was of interest to me because my urology consultant said they would be criticised for not starting salvage RT before it got to 0.4. My oncologist started planning SRT using the " very educated guess and years of experience" scenario when my PSA was 0.2. I was refused a PSMA scan before SRT. My PSA did go down for a short while after SRT but then started to rise again and a tumor was later found outside the  prostate bed. Our hospital will do a PSMA at 0.3.

Salvage RT didn't do me any favours.

"If" it is suitable to let the PSA to rise above the lower limit for a PSMA scan it may be of benefit to some patients.

Thanks Chris 




Edited by member 20 Nov 2022 at 08:26  | Reason: Not specified

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