Salvage radiation therapy with ADT

Some people have been cured after getting salvage radiation. It just varies so much, Some people have it come back after a few years others don’t and can go for decades without reoccurrence. Unfortunately, there is no way to differentiate, It’s just that prostate cancer is different for everyone.

My PSA was undetectable for 2 1/2 years after salvage radiation, But I had two reoccurrences after that.

Have you had hereditary genetic testing?

I’ve never seen someone with absolute zero in their PSA. Is it possible There’s a third digit after .00?

Thank you for responding to my post.
I started my salavage at .4. RP was in 2008. Gleason 3+4.
My urologist wanted to wait till PSA got to .6.
I said absolutely not ,so started salvage treatment with ADT for 6 months Lupron. Finished this regimen in 2020 waited 3 months before first PSA test
results were 0.00 This was in April of 2020. Next PSA test was 6 months that test came back at < 0.02. Next PSA and subsequent PSA have been 0.00. So time passed has been 4 years. Hence my original question. Any comments would much appreciated. Thanks to all.

I'm with https://connect.mayoclinic.org/member/00-6018ad2132cc535a416722/, I have never seen a PSA of 0.00.

Different institutions have different ways they report PSA. Mayo reports only to single decimal point so when the results come back, it says < .1. It could be .09 or .03. My institution measures to two decimal points, their TMDE and Assay cannot measure below .04 so some of mine have come back at < .4 which means it may be .03 but they can't measure below that.

There is some discussion that when there is BCR and it confined to the prostate bed, SRT may cure it. However, you say SRT with ADT which leads me to ask, what was your other clinical data...? For those who are high risk and maybe intermediate risk, ADT is often added to deal with micro-metastatic PCa, too small to be seen by even the most sensitive imaging.

So, cured, maybe, maybe not, time will tell. It can help with providing you our thoughts. Initially after treatment you may be monitored with labs and as necessary, consults every three months for the first two years, then for the next three years it may shift to every six months and after that annually.

Kevin

I do not have additional clinical data.
My PSA had always been 2 digits. Initially it was .04 after open RP. from there it continued to increase I did have positive margins.As I said at .4 decided to do SRT in 2020.
I did have MRI with contrast prior to treatment. Hopefully these good numbers will continue!

It is pretty common that when a reoccurrence occurs and salvage radiation is done ADT is added to try and prevent the cancer from reoccurring again.

That’s a pretty standard technique these days.

ok, the ADT makes sense.

Agree, hopefully your "remission" continues!

If not, there are options!

Yes in my case I had 70.2 Gy. and 6 months Lupron.
It took 11 years before my psa reached .4 .

Hi James,
I have a RP done in 2021, and since then, every 6 months my PSA was less than 0.04, but last year it came just 0.04. I start panicking and couple of days later I redo the PSA and it came less than 0.04. I brought this issue to my urologist and he said is nothing to worry about maybe is just a lab error. Again, it happened twice in a year.
Now I just done my PSA and came 0.05. Not less, just 0.05. I am very worry about and I don't really know how to approach this as it raise a lot of anxiety. Most of the big institutions I heard that they don't even use 3 digits for the PSA.
From your experience, it is possible to get radiation to the prostate bed with this numbers on the PSA?
Also consider orchiectomy as I read that helps a lot.

These are very low numbers! At this point I would wait and see what your PSA numbers reveal. Right now the velocity and or doubling time is VERY slow don’t over think this just watch the numbers and see where they go. Always possible residual prostate tissue.(benign). In my opinion much too early to consider SRT. sweet spot
for this is .2 to .4.
Just keep doing the test and see what it does!

You are getting over anxious. PSA is considered undetectable if < .1. You’re a long way from there. I’ve been hearing people complaining about these ultra sensitive test going up and down for a couple of years. They come to the advanced prostate cancer Ancan.org Weekly meetings with a panicked point of view about their PSA rising .01 or .02. After an RP they do salvage radiation if The PSA hits .2. You are a long way from that. The people that come on complaining almost never have their PSA rise significantly.

I’ve had PSA tests every month for the last eight years. The last 18 months I’ve been undetectable < .1. I could get an ultra sensitive test but it’s not going to really tell me anything more, and could cause me to become over anxious about the result, like you are getting. After 15 years with PC I no longer even worry about what my monthly PSA Test will show, Think about it occasionally, but without concern.

70% of people are essentially cured from their treatment, At least they never get a reoccurrence.. Your PSA may never become a problem, “don’t panic” (Hitchhikers guide to the galaxy)