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Salvage radiation therapy after radical prostatectomy
Prostate Cancer | Last Active: 2 days ago | Replies (90)Comment receiving replies
I am concerned about when is “right” time to do radiation therapy after biochemical recurrence?
I am 75 and in good health. I had a robotic-assisted radical prostatectomy in 09/2020. I had right and left apex and left inferior non-limited (> 3mm) positive margins, however, no adjuvant radiation treatment. Gleason score was 3+4, pT2, pN0. My PSA history is: 12/28/20 & 10/08//21 < 0.1, 04/05/22 .05, 10/07/22 0.05, 03/30/23 0.06, 10/02/23 0.08, 12/26/23 0.11, 2/26/24 0.10, 3/12/24 0.09, 4/30/24 0.09, 9/28/24 0.11, 10/22/24 0.11. My Decipher score is 0.36 (low risk). I had a PSMA PET scan on 3/12/24 that found nothing.
Given these findings, should I undergo salvage radiation therapy (SRT), and, if so, when should I start? I fear that SRT poses inherent risk to urinary control, bowel function and e.d.. I already have e.d. from the prostate surgery; it is the other side effects (possibly, for the rest of my life) that I really fear. Does anyone know where one can find statistics for how many people suffer long lasting side effects after SRT?
My local radiation oncologist wanted to start SRT last spring. He felt that the PSA readings: 0.05, 0.06,0.08, and 0.11 constituted a biochemical recurrence. I postponed SRT until this fall because my next PSA readings: 0.1, 0.09, 0.09, 0.11 were generally stable and the PSA value was rather small (0.11). I met the same radiation oncologist in early October and he again wanted to start SRT. I recently got a second opinion from a radiation oncologist (from Mayo) who reviewed my case and suggested it was too early to start SRT and active surveillance was called for. So I postponed SRT until at least January 2025, when we will reconsider the course of action based on future PSA results. I feel that treating the recurrence too early leaves me open to possible side effects for a longer period of my life. On the other hand, I have read that undergoing SRT while the PSA is very low increases chances of eliminating the cancer.
I am sure many readers of Mayo clinic connect have faced this dilemma. Any advice or sharing of similar experiences would be really helpful to deciding if, and when, to start SRT. Thank you,
Replies to "I am concerned about when is “right” time to do radiation therapy after biochemical recurrence? I..."
Hey Jackie, I totally get where you are. I hit the magical .2 myself a few months ago - 5 yrs post surgery.
I am currently on ADT for 6 months (not so bad so far after 3 months) and will have 25 sessions of radiation in about 10 days. I am impotent already from the surgery so it’s not a concern for me any longer😩
My scans were all negative ( no Decipher score) as my RO predicted they would be. I have the same fears as you but my fear of the cancer is worse….period!
To me - given my personality - it’s not a choice to wait; I am compelled to act sooner rather than later.
You may be different, less excitable and that may prompt your decision to wait. Your Decipher score is definitely in your favor - they did not have this in 2019 - but you still had a Gleason 3+4, which is not considered aggressive but in this gray intermediate area.
At age 75 it might be a coin toss since it could take many years to actually spread and something else could get you by then, right?
You seem to be closely monitored now so you are OK with waiting but if your PSA suddenly accelerates you will probably have to do something.
Best to you Jackie!
Age 72 RP Aug 2022
Nov 2022 1st PSA 90 day postop .19
Called Persistent PSA and considered BCR.
Began Salvage Treatment February 2023 - 37 radiation treatments together with short-term ADT.
4 subsequent uPSA tests all undetectable < .02
Radiation side effects went away 2 - 4 weeks after radiation treatment ended. No additional side effects from radiation.
Now 74.
My understanding is that the sweet spot for Salvage treatment is PSA .2 - .4/.5
See SPPORT trial.
Seems that ADT may or may not be prescribed; some evolving philosophies and protocols.
Best to you with your choices.
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Dear friend...
First, my best wishes towards your journey...
Generally, PSA level above 0.2 are consistent with biochemical recurrence and fortunately, you are below that.
You also have favorable risk profile (Low risk), low gleason, long doubling time.
Your concern about salvage radiation therapy side effects are reasonable.
Radiation oncologist will look towards trying to cure but side effects are something else, they report it to be wide range, overall considered low but some do have significant. Unfortunately, cure is not free.
It then comes to individual choice whether you are comfortable monitoring or try to do early therapy.
My surgery was in Feb 2020 and last PSA is 0.19. My radiation oncologist did recommend therapy at one point but since it is below 0.2, he thinks it is reasonable to monitor. At some point, it looks like I will need it but I am avoiding as long as possible.
Best regards...