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salvage treatment now?

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User
Posted 02 May 2026 at 16:01

I am a 75 year old male in relatively good health. I am not sure whether to begin salvage treatment now or not.

Four years and two months after prostatectomy my PSA had slowly risen to 0.20. Doubling time averaged about 16 months. Urologist had me do a PET scan then (Jan 20, 26) which showed no cancer. Had me do another PSA 3 months later which was 0.22. We discussed this and what to do and he felt I was in the middle of requiring salvage treatment or not. I asked about having another PSA test done in 3 months and he concurred but suggested 6 months instead. He also scheduled me to speak with a doctor in radiation oncology.

The radiation oncology doctor felt fairly strongly that I should begin radiation and hormone treatment right away. I don't know what to do and appreciate your thoughts and advice. 

Thanks, Jimmy

User
Posted 03 May 2026 at 05:25
Really depends on the G score and how long you expect to live.

If you were high Gleason and are otherwise fit and well it's probably best to take the radiation and HT.

If you were low risk at final pathology and otherwise fit and well it's more nuanced. You could do HT and RT, just RT or watch and wait.

User
Posted 03 May 2026 at 13:36

Thanks very much for your reply. I don't understand the Gleason score etc so I copied this from my doctor's notes. Thanks again.

radical prostatectomy on 10/15/2021. PSA was 8.7 prior to surgery. Pathology from the surgery revealed pathologic stage pT3 pNO adenocarcinoma of the prostrate, with Gleason score 3+4, positive ECE, no seminal vesicle involvement. Margins were negative but close (less than 0.01 mm).

User
Posted 04 May 2026 at 08:00
Ok so that is probably "low risk" so you have the dilemma of choice. If you are still struggling with the choice (treat OR wait for scan detection) perhaps consider a second oncologists option ideally from a large teaching hospital so they have a chance of being up to date.
User
Posted 04 May 2026 at 12:42

Yes. I will get a second opinion from another radiation oncologist. Appreciate you.

 

User
Posted 04 May 2026 at 13:29

How low did your PSA go after the prostatectomy?

User
Posted 05 May 2026 at 22:54

  <0.01        0.01         0.01         0.03         0.04        0.05       <0.10         0.155        0.14        0.20           0.22

2/24/22    6/21/22  9/29/22   3/29/23   6/15/23   9/27/23   9/24/24    6/24/25   9/29/25  12/30/25    4/9/26

Appreciate your concern, input.

Jim

 
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