Post RP radiotherapy

Whether it is called adjuvant or salvage RT is a sematic issue in many ways but technically, adjuvant RT is planned prior to the RP or identified as necessary during the op / by the first post-op PSA. Salvage RT is when it was believed that the primary treatment had worked but there is then a biochemical recurrence.

The 0.2 limit is quite old but was set at that level because it is possible for a man with no prostate to generate up to 0.2 from benign cells and / or other organs. However, if a man had undetectable PSA which then rises above 0.1 and keeps on rising, the likelihood is that this is not benign. If a man had a poor post-op pathology, there may be no point waiting for the PSA to reach 0.1 - just need to get on with the RT.

My husband has had RP and SRT - his PSA has been wobbling between <0.1 and 0.11 for the last 5 years or so but has never gone back over 0.11 so the onco thinks he may just produce a lot of benign PSA.

Like others I am impressed by your continence and erectile function, and hope that this treatment (hopefully avoiding hormone therapy) won't impact that.

But I agree, all Ian's figures are lower than the reporting limits at your hospital (and also mine) so they hardly represent a significant amount. It may be the doubt over the margin is the reason for referral. But then the referral is only for consideration by the consultant who would oversee the radiotherapy, it isn't a decision to do it - but having said that I have a feeling there have been trials of going straight to adjuvant RT where there are problems with margins, and it may be deemed beneficial in Ian's case.

On my post op histology report (note I had in op Neurosafe frozen section) each section is marked with a different coloured ink and the inking protocol is defined. Right=red, left= blue etc. I'm just guessing, but perhaps red= red is a typo and should be right = red. Perhaps CS is centre section????

Peter

Are you sure you have the right numbers?

Evening Ian.

May I congratulate you on your continence and for having no ED issues. This appears to be rare, so quickly after the op.

I had RARP in Feb 2023. I was T3a with EPE, Gleason 9 (4+5), Grade group 5.  I was told that 0.2 ng/ml would indicate possible recurrence and possibly trigger further treatment.. Since then my PSA has been <0.02, <0.05, <0.02, and <0.02. All these figures were the lowest the labs measured to. The slightly higher one was done at a different hospital.

I find it hard to see why at this stage you're being considered for salvage RT?

Adrian

Edited by member 05 Feb 2024 at 19:32  | Reason: Not specified

Hi J_B

I still don't follow. ART is also called ESRT early salvage radiotherapy. Ian's and mine PSA levels maybe very similar my Gleason score is much higher  and I have extra prostatic extension, the capsule is breached so why am I deemed less risk? I haven't got a clue what my margins are, I've never been told?

Adrian

I am confused by the different levels at which referrals to oncology are made. My op was just over two years ago. Initial reading was undetectable. Since then it has slowly risen to 0.1 last month. My surgeon has now asked for the next test to be in June, that is a six month interval. Perhaps he is waiting for the magic 0.2 or to see if it levels out? 

Peter

Surgeon consultant thinks it's either cancer growth (in which case PSA will rise quickly and over 0.2) or benign glandular tissue growth (in which case PSA would rise and plateau below 0.2). Either way, he doesn't think there is a need for urgent action.

I wish they could come up with a more meaningful marker for prostate cancer that distinguishes between malignant and benign tissue!

Anyway, it seems to me that a PSA rise of <0.01 to 0.1 over a 6 month period is quite fast, therefore indicative of cancer return, and should qualify for SRT even if 0.2 has not been reached yet. I find this 0.2 limit a bit artificial. How was it arrived at? Is there a rational behind 0.2?

Maybe I am panicking. Maybe it is possible for PSA to rise and stabilise somewhere below 0.2?

I have copies of all my medical records. Margins have only been mentioned once.

Following my first MRI and biopsy in a letter to my GP from the consultant he wrote I had reasonable safety margins.  I presume this meant that the foci of the two tumours (one visible on the MRI and the other detected by the biopsy but not seen by the MRI) were safely contained within the prostate away from the outer edges?

Margins are never mentioned again.

In the examination report of my removed prostate it showed that I had EPE, T3a but fortunately the seminal vesicles, nodes and fatty tissue that were also removed, were all clear. So does this mean,  post op I had negative margins?

Edited by member 08 Feb 2024 at 09:18  | Reason: Not specified

Presumably, the scan was triggered by the 4 consecutive rises, miniscule though they were.

At one of my local hospitals they only measure to 0.05. So had you had the tests there, they would have all come back <0.05 and all been classed as undetectable.

Edited by member 09 Feb 2024 at 07:48  | Reason: Typo