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Ductal prostate cancer: Radiation + hormone therapy or surgery?
Prostate Cancer | Last Active: Nov 22, 2024 | Replies (18)Comment receiving replies
If the PSMA shows no spread beyond the prostate, which is the situation here, why would you recommend going to radiation as soon as surgical recovery is complete? Where are they going to radiate? My surgeon was very clear on this- they would not under any circumstances recommend I begin radiation and put me on ADT until they can actually see evidence of biochemical recurrence. Otherwise they are literally shooting in the dark. If there is a 20-30% chance you will not have a BCR, they will not put you through these kinds of very highly aggressive treatments with all of their potentially major side effects until the evidence shows that you indeed have a BCR, or in other words, until the chances you won't have a BCR go to zero.
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What is a BCR?
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Hey Tango, Yes, I was told the same thing and my PSA went to .18 5 yrs after surgery and here I am in salvage radiation.
At .18 my PSMA scan was negative also. Yet I am led to believe that most - if not all of them - show NOTHING under .5 - .7…..Salvage radiation is ALSO shooting blind. You are radiated from just above the prostate bed and then downward into the pelvic lymph nodes. You are blanketed by the beam top to bottom and from the posterior as well - 360 degrees.
The only time the PSMA is truly useful is in metastases large enough to show by tracer uptake. These areas are usually pinpoint targeted by SBRT and dealt with quite successfully.
Also remember that no surgeon sends his patient for radiation unless the pathology comes back with PCa cells in the lymph nodes - or there is a broken capsule, etc. The surgeon always wants the patient to believe that their efforts were totally successful. My surgeon told me at my consult that due to my Gleason 4+3 and how widespread it was in the gland (don’t know any of the other morphological patterns present) that even with his best efforts “this could still come back”.
If he had given me actual numbers like 50%? I would have done what I said in my post. Also, this is MY opinion of what “I” would do facing similar circumstances - NOT an endorsement of treatment for anyone else. I thought I made that clear in my post. Apologies for any confusion.