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Salvage radiation decision: with or without hormone therapy?
Prostate Cancer | Last Active: 1 hour ago | Replies (30)Comment receiving replies
Jeff - thanks for all the information you have been providing on the questions I've been asking. You are very knowledgeable about the current research and treatment options. After reading the messages from you and others, it seems like ADT slows down cancer growth, but doesn't kill the cancer cells. And the only way to actually kill the cancer cells is through surgery or radiation. Also the cancer cells can mutate to make them ADT resistant. So it seems there is a high probability after ADT treatment that the cancer will eventually come back, and could become castration resistant.
I'm 64 and currently have a PSA of 0.2 after 4 years post RP, PSADT of 1 year, post RP clean margins and lymph nodes, and a negative PSMA/PET scan. I didn't have a decipher test done at the time of RP surgery. In a Dr. Kwon video, his recommendation was to wait until a scan positively identifies the cancer spot and then kill it with radiation. I'm hoping to get into Mayo soon to have a Choline 11 scan done. If that is also negative, does the current body of research support waiting until a scan identifies the cancer? Are there stats showing the effectiveness of waiting to identify the cancer and using radiation to kill it? For example, after this treatment plan, how many patients have their PSA increase again and have additional radiation treatments?
I believe I saw a statistic that salvage radiation to the prostate bed is about 30% effective at killing all remaining cancer cells with a PSA around 0.2 - is that correct? Are there stats showing how much more effective adding the ADT therapy on top of the radiation is?
Lots to consider and I appreciate your help and everyone else who is contributing to this forum! I will continue to share my treatment plan and effectiveness as well. A Huge Thank You To Everyone!!
Replies to "Jeff - thanks for all the information you have been providing on the questions I've been..."
The SPPORT trial may provide some information relevant to your inquiries.
My understanding is post RP PSA of .2 - .4/.5 is the "sweet spot" for Salvage Treatment.
Post RP my 1st PSA was .19 (persistent) and the treatment at Johns Hopkins was Salvage Radiation to the whole prostate region together with the pelvic lymph nodes together with short term ADT.
2 PSMA Pet scans, 1 preop and 1 post-op did not identify specific areas of recurrence.
2 friends with 2 different ROs at JH received similar treatment.
All 3 of us have had undetectable PSAs for about 2 yrs now since completing salvage treatment.
Personally, I would take the negative PSMA PET together with the relatively low PSA as an opportunity to treat the recurrence at an early opportunity. Layman understanding and experience.
Best wishes.
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You have had a lot of important points, Chuck. With your low PSA it sure seems you should wait until you have a fast Doubling time, and your PSA is higher, before you start worrying about the options below. You are at .2, How fast did it get there?
Here are Some things that relate to having Reoccurrence with or without metastasis
At the recent PCRI conference it was mentioned that only 1/3 of the people that get salvage radiation benefit from it, In that they have no further remission.
Both Dr. Kwon and Dr. Scholz Are real enthusiasts about using SBRT to just zap the metastasis and you can go home happy and not worrying about it.
These two things sort of collide together. Currently the SBRT scan cannot see metastasis smaller than 2.7 mm and in some case even at 5 mm It can’t always be determined (from recent UCSF conference).
That means you could be waiting for metastasis to show up while many other mini metastasis are growing. Because the prostate is removed the area around there is the most likely place that something could have microscopically spilled and be spreading. As was mentioned in the PCRI conference “Seeds for metastasis were already there when surgery was done, waiting to grow.” That’s where salvage radiation becomes to make some sense.
It could be the C11 scan can detect smaller Metastasis.
Dr. Scholz was real emphatic, At the PCRI conference, about using the SBRT technique to keep his patients in remission.
So now you have a little bit of both sides of that story.
As for adding ADT if you’ve had a metastasis or remission, ADT is normally the recommended treatment. Even an ARSI may be used at the same time if the cancer looks like it could be aggressive.
Here is a treatment guide I got from one of the Conferences.. Anti—hormones is referring to drugs like ADT.