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PSA level for SRT

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User
Posted 18 Jun 2025 at 12:04

I'm interested to know what PSA levels people are being offered salvage radiotherapy. My consultants are claiming they do nothing until 0.4 and even then they may wait longer as they want to do a PET scan before any treatment. They claim this is standard proceedure.

User
Posted 18 Jun 2025 at 13:13

Hi,

It was back in May 2022 so three years ago. 

Edited by member 18 Jun 2025 at 13:14  | Reason: Typo

User
Posted 18 Jun 2025 at 20:31

It was the radicals trial that has changed things significantly in the past 5 years it's conclusion was:
"Conclusion
Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy."

I happened to be seeing a consultant 3 years ago who knew a lot about the radicals findings and she stated that there was no observable benefit going before 0.2 and very little observable benefit going before 0.4. But not to go past 0.5.

So it sounds like your consultant has latched onto this approach. It's still shocking you were not informed of your PSA rise.

PS if there are positive margins these rules do not apply.

Edited by member 18 Jun 2025 at 20:35  | Reason: Not specified

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User
Posted 18 Jun 2025 at 12:54

Hi,

I was referred to oncology at 0.12 following two previous rises, 0.07 and 0.1, I had a discussion with my surgeon and he agreed to refer me, but then my post op histology showed a positive margin which added weight to my referral. 

Hopefully others will comment. 

Good luck, 

Kev.

User
Posted 18 Jun 2025 at 12:57

Thanks for that, can I ask how long ago this was?

User
Posted 18 Jun 2025 at 13:13

Hi,

It was back in May 2022 so three years ago. 

Edited by member 18 Jun 2025 at 13:14  | Reason: Typo

User
Posted 18 Jun 2025 at 13:53

Gareth , I had surgery in 2014, at that time 0.1 brought me back under the urology umbrella and 0.2 prompted action. I had the very educated guess SRT treatment in 2017. I didn't have a PSMA scan. In July 2022 with a PSA of 1.4 a PSMA scan showed pelvic lymph nodes involvement, early this year I started decapeptyl and apalutamide.

Research and data is a moving target, detecting cancer cells is difficult, a PSA of 0.023 may show something with a PSMA scan,a PSA of over 200 may not show anything on a PSMA scan. 

The rate of rise may be more important. What is standard at your hospital may not be standard at another hospital.

Thanks Chris 

 

Edited by member 18 Jun 2025 at 13:56  | Reason: Not specified

User
Posted 18 Jun 2025 at 15:15
About 8% of men produce insufficient PSMA for that scan to work, regardless of their PSA. For such men an alternative scan, (There are several), would be a more relevant diagnostic tool.
Barry
User
Posted 18 Jun 2025 at 20:31

It was the radicals trial that has changed things significantly in the past 5 years it's conclusion was:
"Conclusion
Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy."

I happened to be seeing a consultant 3 years ago who knew a lot about the radicals findings and she stated that there was no observable benefit going before 0.2 and very little observable benefit going before 0.4. But not to go past 0.5.

So it sounds like your consultant has latched onto this approach. It's still shocking you were not informed of your PSA rise.

PS if there are positive margins these rules do not apply.

Edited by member 18 Jun 2025 at 20:35  | Reason: Not specified

User
Posted 18 Jun 2025 at 21:19

Ah, I had positive margins! Are these rules from nice?

 

User
Posted 18 Jun 2025 at 21:20
In my case (with a small region of positive margin) urology were on alert as soon as PSA exceeded their reporting limit of 0.05, but didn't act until it had exceeded 0.2 in early 2021. They said that sometimes there can be a small rise after surgery that then stabilises.

However they and their oncology colleagues didn't want it to go far above 0.2 (it did reach 0.3 before starting ADT prior to radiotherapy, with Covid slowing treatment). They said that there was no point in a scan under a PSA of 0.5 (i.e. they couldn't take a negative scan as a justification for no action) and that the probability of success was much better acting sooner.

Obviously that is just one hospital, and in a case where there was a positive margin.

 
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