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BCR 3 years after savage radiation and 4 years since robotic prostatectomy what comes next?

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User
Posted 24 Sep 2026 at 21:01

Hi again. It has been a few years since I posted and am posting again, i had hoped this cancer was done with.


My PSA was <o.1 for 3 years after post operative salvage radiation. In June this year my psa was 0.1. Now 3 months later it is 0.2.


I believe I now have a BCR recurrence.


This news has knocked  me for 6. I see my radiation doctor in 4 months and am due another PSA in 3 months.


My original cancer was Gleason 4+3 with positive margins at surgery and a post operative psa of 0.7 but negative PSMA scan hence the salvage IMRT in 2023.


Any thoughts greatly appreciated.This has hit me hard.

User
Posted 25 Sep 2026 at 15:33

Hi Steve,


my prostatectomy was a failure from the get go too and I have had salvage RT but it will be a while before they test to see if it has worked so I am in that awful state of Limbo that we all experience awaiting results.


I would ask your doc for a PSMA PET scan to see if they can find the source for the PSA which is likely to be a tumour somewhere and targeted Lutetium 177 treatment sounds v promising to me.


In the UK they can then use targeted treatment like SABR radiotherapy to deal with one or maybe two tumours but more than that they may decide on another approach.


I have been looking in to injectable Lutetium 177 treatments that use a radioactive ligand which is attached to a molecule that binds to cells expressing PSA and it is very focused as the the radiation only travels very locally and so kills the tumour without damaging the healthy surrounding cells much.


They make it very difficult to get a PSMA PET scan in England and even more difficult to get L177 treatment which they reserve for late stage metastasis.


However I think in Canada you are much more likely to be able to obtain it as the radioactive materials are actually made there and I have read of people having it at your stage with good results.


Crispin who posts on here has had it and has not needed the full 6 injections 6 weeks apart as PSA dropped nicely after just two rounds which is very encouraging indeed.


Best 


Al


 

User
Posted 25 Sep 2026 at 19:36

Again in England so probably different protocols, I had surgery in 2014. I had BCR, three years after surgery and again after salvage RT. A PSMA scan found a pelvic tumor which was treated with SABR, another year on  I had another recurrence and I used our medical insurance for more SABR to another pelvic lymph node.


Two years ago a PSMA scan found too much spread for any more SABR treatment.  We looked at lut177, but I was not suitable. Around 18 months ago I started on decapeptyl and apalutamide, the PSA has remained below 0.03.


Thanks Chris 

User
Posted 26 Sep 2026 at 05:18

Thankyou to you all for your support and treatment ideas. I will contact my radiation doctor and see what the next steps are.


As an aside, we drove north to Edmonton today  to see my daughter who is working there. It put things into perspective a little more and helped me cope better with the uncertainties of living every day with this cancer.


i will update soon.

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User
Posted 25 Sep 2026 at 10:42
yes I know what it's like to appear to have beaten this thing only for signs that it has maybe not. Perhaps you might have a PSMA scan, as I see you have had previously. It rather depends on what can be seen and whether any mets are able to be treated. A systemic treatment may be called for, chemo and or a form of HT really depends on how your oncologist decides. He/she may want to give it a bit longer and rule out other possibilities in the first instant. But you should explore this, even having urine and blood tests via GP first.
Barry
User
Posted 25 Sep 2026 at 15:04

Thanks I will call my radiation docs office and see if I can see him sooner. From the last visit he wanted PSA every 3 months and will see me in January. That seems like a long time to  wait.


thanks for the support

User
Posted 25 Sep 2026 at 15:33

Hi Steve,


my prostatectomy was a failure from the get go too and I have had salvage RT but it will be a while before they test to see if it has worked so I am in that awful state of Limbo that we all experience awaiting results.


I would ask your doc for a PSMA PET scan to see if they can find the source for the PSA which is likely to be a tumour somewhere and targeted Lutetium 177 treatment sounds v promising to me.


In the UK they can then use targeted treatment like SABR radiotherapy to deal with one or maybe two tumours but more than that they may decide on another approach.


I have been looking in to injectable Lutetium 177 treatments that use a radioactive ligand which is attached to a molecule that binds to cells expressing PSA and it is very focused as the the radiation only travels very locally and so kills the tumour without damaging the healthy surrounding cells much.


They make it very difficult to get a PSMA PET scan in England and even more difficult to get L177 treatment which they reserve for late stage metastasis.


However I think in Canada you are much more likely to be able to obtain it as the radioactive materials are actually made there and I have read of people having it at your stage with good results.


Crispin who posts on here has had it and has not needed the full 6 injections 6 weeks apart as PSA dropped nicely after just two rounds which is very encouraging indeed.


Best 


Al


 

User
Posted 25 Sep 2026 at 16:15
I will take a look at Crispin's post. I have contacted Novartis as they have a BCR Lutetium trial active now. It lmay be a better initial option than lifelong hormones.
User
Posted 25 Sep 2026 at 19:27

I would prefer it to hormones.

User
Posted 25 Sep 2026 at 19:36

Again in England so probably different protocols, I had surgery in 2014. I had BCR, three years after surgery and again after salvage RT. A PSMA scan found a pelvic tumor which was treated with SABR, another year on  I had another recurrence and I used our medical insurance for more SABR to another pelvic lymph node.


Two years ago a PSMA scan found too much spread for any more SABR treatment.  We looked at lut177, but I was not suitable. Around 18 months ago I started on decapeptyl and apalutamide, the PSA has remained below 0.03.


Thanks Chris 

User
Posted 25 Sep 2026 at 20:00
Thanks SteveCAN for your posts, which are very timely for me to be reading. Thanks also for posting that this trial is recruiting. I had heard of the trial but hadn't checked the sites. It looks like there are several trial sites in Canada and some in UK. What I am reading looks like a Phase 3, SABR + Pluvicto or SABR and observation alone. We are heading in your direction (but with very different initial presentation, unfortunately for us) and different treatments so far but none look like an exclusion. For those reading, looks like one of the requirements is either no ADT or ADT has to have stopped a year before starting on the trial.

Many sites around the world too.

Wishing you all the best and good luck pursuing this trial.
User
Posted 26 Sep 2026 at 05:18

Thankyou to you all for your support and treatment ideas. I will contact my radiation doctor and see what the next steps are.


As an aside, we drove north to Edmonton today  to see my daughter who is working there. It put things into perspective a little more and helped me cope better with the uncertainties of living every day with this cancer.


i will update soon.

 
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