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When do I need Radiotherapy ?

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User
Posted 30 Jan 2023 at 18:45

Prostectomy in July 2022. Have had 2 blood tests since, both times PSA was 0.01


Was told that won't do Radiotherapy until or if the level is raised. But raised to what level, 0.02, 0.2, 2.0 ?


Is there a "number"which triggers the need for Radiotherapy and would it be at the first increase or would they wait until it increases over a period of time?


Grateful for information.

User
Posted 31 Jan 2023 at 13:06
Sorry I can't give you a definitive answer but unless it is a very large initial jump which is unlikely, your Consultant will probably want to look at how high and quickly PSA increases over a few tests in your individual case as this can give a clue as to where any cancer may be. Also Consultants can sometimes disagree when to for example to perhaps follow up with a scan and radiation or whatever. Although progression in patients may differ, Consultants use there experience to decide on when and what the next step will be in an individual case.
Barry
User
Posted 31 Jan 2023 at 14:11

RP September 2022


I can only speak for my consultant who said if my PSA went to 0.1 then he would refer me for a scan.

User
Posted 31 Jan 2023 at 14:33

My husbands PSA tests have all been <0.025 which is undetectable to us and your is less than that so hopefully you won’t ever need it. (Obviously we don’t know what his exact figure is)


We were told that if my husbands PSA reached 0.3 that’s when he would have a PSMA pet scan…I’m not sure if that’s too long to wait but I think they worry it won’t pick anything up if done earlier.

User
Posted 31 Jan 2023 at 16:39
The NHS definition of post-RP biochemical recurrence in England is 0.2 or three successive rises above 0.1 or 0.1 with known positive margins post-op. If a patient has biochemical recurrence, the urologist should refer them straight to oncology. The oncologist decides when / whether to do salvage RT. There is a very small number of uro-oncologists in this country, who can do RP and RT so no need to refer to oncology, but it really is an exceptional situation.

Biochemical recurrence post-RT is 2.0 + nadir (the lowest reading the patient has ever had)
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Feb 2023 at 10:17

Many thanks Barry, that helps.

User
Posted 02 Feb 2023 at 10:18

Thanks for the info Jim.

User
Posted 02 Feb 2023 at 10:28

Thanks Lyn


Not sure if I understand.


If my PSA comes up as 0.2 then cancer is still there, but they won't actually do anything until three "jumps" or it reaches 2.0.  Is that correct?


 

User
Posted 02 Feb 2023 at 11:24
The location of cancer cells may not be seen on scans until there is a concentration, so the best chance of dealing with them is to be able to see where best to direct RT and the higher the PSA the better the chance of seeing them. However, from experience and the way PSA increases Oncologists may feel for example that the cancer cells are in the Prostate bed and concentrate RT there. You can't just deliver RT all over the place. So some men will get salvage RT earlier than others with varying PSA depending on what is seen or strongly suspected.
Barry
User
Posted 02 Feb 2023 at 12:13

Originally Posted by: Online Community Member


Thanks Lyn


Not sure if I understand.


If my PSA comes up as 0.2 then cancer is still there, but they won't actually do anything until three "jumps" or it reaches 2.0.  Is that correct?


 



Sorry, no - I haven't explained it very well. If a man has had his prostate removed, biochemical recurrence is 0.2 or three rises above 0.1 - that is the point at which urology should make a referral to oncology. Oncology may act straightaway or they may wait for the PSA to rise a bit more.


If the man has had radiotherapy but not surgery, biochemical recurrence is 2.0 +  but additional treatment may be held back until the PSA reaches 5 or 10, or the doubling time has got shorter. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Feb 2023 at 14:10

Cheers Barry. Thanks for the info

User
Posted 02 Feb 2023 at 21:11
Bugatti Blue (fantastic user name), although one could argue any detectable PSA after surgery is a worry, a notional value of 0.01 is taken as indistinguishable from zero by many labs. As stated above the typical criterion for referral to oncology is 0.2, although they should take action if successive readings suggest a fast doubling time.

In my case, they didn't actually do anything (prescribe hormone therapy) until PSA was clearly above 0.2, there had been previous readings hovering just about that level.
User
Posted 02 Feb 2023 at 21:25

Thanks for your reply JT 


You mention Hormone Therapy, did they not offer/suggest RT when it got above 2.0 ?


 


 

User
Posted 02 Feb 2023 at 21:26

Hi,


A psa of 0.01 is very low.  Two readings at that level is no change.


Change in psa and the rate of change are the main factors takens into consideration.


Most hospitals only read down to 0.05 or 0.1 and until it reaches that level it's usually not a concern unless there are special features such as positive margin as Lyn mentions. 


If it rises with a doubling rate of say less than 3 months then lights will start flashing to keep an eye on it.  At levels like 0.01 doubling might only be a change from 0.015 to 0.016 which would be absolutely nothing at all. 


A 0.03 the test is more credible and doubling from say 0.03 to 0.06 is getting into the range of real numbers.


Mine is 0.08 and rose from 0.06 in 12 months.  As many wouldn't be aware of it as their hospital works at 0.1 I've not been over concerned.  Also it had one unusually high reading then dropped for the next readings so you can't take single results as meaningful.

User
Posted 02 Feb 2023 at 21:29

That information is helpful. Many thanks


 


 

User
Posted 02 Feb 2023 at 22:08
Sorry, wasn't clear. Once they had decided to do something, they initiated hormone therapy in preparation for radiotherapy. The HT alone caused PSA values to plummet, but of course I am hoping the RT makes the drop permanent now I have stopped HT. It will take a little longer to know whether it has worked.
User
Posted 02 Feb 2023 at 22:43

BugattiBlue, not sure if Spain uses the same figures and approach as they do in the UK. 


Thanks Chris 

User
Posted 03 Feb 2023 at 09:25

I'm using one pad per day but none at night. It's 6 months since catheter was removed but I still dribble.


The first 4 months my incontinence improved fairly quickly ( from 4 pads per day down to 1).  So I seem to have "hit a wall" as there's not been a significant improvement over the last 2 months.


Consequently not looking forward to Radiotherapy as everything I've read indicates incontinence increases as a result. It sounds like HT would be far preferable but I suspect there's a catch somewhere. Can anyone explain what it is?


 

User
Posted 03 Feb 2023 at 09:40

Hi Bugatti Blue,


Can I ask why you think you will need any further treatment at all? Did you have positive margins on your post op histology report, or had the cancer been known to leave the prostate?


I’m sure people better informed will let you know but my understanding is that HT alone won’t cure (not a word to be used on here really) the cancer but will just suppress it and it will only work for so long (some a few months, some lots of years) before you would then have to move onto a new treatment. RT should kill the cancer cells and would usually be given with curable intent.


Fingers crossed you will never need any of these 👍

 
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