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Rising PSA years after radical prostatectomy
Prostate Cancer | Last Active: 23 hours ago | Replies (215)Comment receiving replies
Phil,
Thank you for sharing your experiences with salvage radiation. I am so glad that it has worked out well for you. Two questions: did you have the radiation done at a “center of excellence” or a local facility. Was it IGRT or IMRT or proton radiation?
At this moment I am in a different “place” than in March, 2024. I am in “watchful waiting” mode. Following my last post (March 3, 2024) I have had the following PSA results: 3/12/24 0.9, 4/30/24 0.09, 9/28/24 0.11, 10/22/24 0.11, and 1/03/25 0.11. Based on the latest results (and having a Decipher score of 0.36) I have decided to just sit still for a while and see how this plays out. The decipher report says that, in my case, radiotherapy prior to a rise in PSA above 0.2 does not lead to improvements in the outcome. So, in the future I will be having PSA test every three months and when the PSA gets to around 0.2, and assuming my overall health is favorable, I will probably have salvage radiation. Because of the low PSA and the Decipher results I probably will not do any ADT.
My radiational oncologist and urologist tell me that they have not seen many cases where the PSA “stalls” for a significant period of time. They both speculated that perhaps the entire prostate was not removed but that is unlikely. Time will tell.
To people who see an increase of PSA after radical prostatectomy I would say that there are three important considerations: 1) your PSA doubling time, 2) your Decipher (or similar genomics tests) results and 3) the actual value of your PSA. My feeling is that you treat aggressive recurrent cancer at a low (lower than 0.2) PSA and you treat recurrent cancer that is not aggressive at a higher level of PSA (perhaps, even a bit above 0.2). I must emphasize that I am not a medical doctor and those are simply my opinions based on what I have read.
Thanks again for sharing your story with me. I will write a continuation of my “journey” when I start salvage radiation.
Replies to "Phil, Thank you for sharing your experiences with salvage radiation. I am so glad that it..."
My Salvage Radiation treatment was IMRT at Johns Hopkins; 37 txs; total 66.6 gy to whole pelvic region and pelvic lymph nodes.
Also had 4 mos ADT Orgovyx.
See SPPORT trial.
Note: A friend who had RP (3 or 5 yrs ago) now has rising PSA around .2 and is scheduled for Salvage Radiation at a MD Anderson affiliated location in NJ; however ADT is not being prescribed.
I am not a MD and have no opinion on the "ADT or no ADT " treatment, but wanted to report my friend's experience for informational purposes to you.
My PCa was a Gleason 9, so I am probably grateful that I had ADT, and worry that it should have been a longer course of ADT. However I certainly found the ADT to be a burden. Ok, ADT sucks; if necessary, then so be it.
Best wishes.
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Hey Jackie, sounds like you have a plan - a good one. I think the docs are right in that PSA doesn’t just stall out; but mine took quite some time (5yrs) to hit the magic .2 and even then it bounced up and down for the last year until finally hitting .18.
I had IGRT radiation, since every day at treatment the machine would do a cone beam scan of my insides to check for gas, stool in the rectum, bladder fullness and relative position of all the organs to each other. Only once in 25 sessions was I kicked off the table for too much gas in the rectum, which is a very critical area.
Still amazed at the technology, even though we always use terms like fried, zapped, cooked, etc to describe what was done. My RO explained that they can actually “shape” the beam to go around the rectum but not thru it; the machine - a Varian TruBeam- actually goes underneath you and radiates you from the back as well….really amazing technology.