Adjuvant Radiation Therapry (ART) vs Early Salvage radiology

no problem. I thought i bookmarked that link, but I will find it and send to you.

From the research i have done so far, it is a mixed bag (ART vs. salvage). The clinical studies that have been done dont take appear to take into account IDC-P and cribiform as risk factors. As someone indicated, they moved their Gleason from 7 to 9! I suspect that is the same for me.

I am just starting my research and hope to find another opinion or two on this mess. it seems like for IDC and cribiform, its the wild west! no one really knows what treatment options work, no clinical studies, etc. ill keep you in the loop. Im considering anjuvant radiation as the most pragmatic option, but have some homework to do.

Best of luck to you and your husband. Stay in touch!

If you dont mind my asking, what were your your Gleason scores, margins, invasions of lymph/ vesicles, etc. And how extensive was your IDC-P and cribiform? Just trying to compare our situations.

So you did Adjuvant - within 6 months of surgery without a rising PSA, as opposed to salvage - waiting for the cancer to show up on a PSMA/PET before you did anything. Im leaning your way. i dont want to wait until it matastizes......

@surftohealth88
https://www.uclahealth.org/news/release/KishanJAMAOncol2022
article about the Mirage randomized trial comparing MRI guided radiation to non-MRI guided.

@mlabus3
If it were me, I would try and minimize the exposure of healthy tissue to radiation and that would mean choosing an MRI guided radiation machine that sees imaging in real time. What they see, they can treat. The two machines that do this are the Mridian and the Elekta Unity.

Jeff makes a good point. Adjuvant/salvage radiation is not the pinpoint accurate type that MRI guided gives in primary therapy, where margins are smaller than traditional IMRT or Cyberknife.
Instead it is more of carpet-bomb approach with no margins. Today, they target the prostate bed AND pelvic lymph nodes…it’s a very wide area. And, they still use photons no matter what, so is there any advantage to using MRI at all?
Proton radiation is different in that it reduces the radiation that ‘passes thru’ the target area. We’ve discussed this on the forum before as to whether it even matters in salvage/adjuvant setting - proton proponents say it does.
When I had my salvage photon IMRT treatments, the beams went from above, below and from the sides and went right thru me in order to kill/weaken whatever cells might be lurking anywhere. Software allows these beams to be ‘shaped’ around the rectum and bladder but still some radiation must hit these structures. Nothing’s perfect.
Pick your poison, but either way side effects are inevitable in any treatment. Best of Luck,
Phil

Just wanted to post this and have to run to help my husband get ready for catheter removal . TTL
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html?tmpl=component&print=1

Hard to believe how much a difference having adjuvant radiation with a >=.4 decipher score differs from waiting for a PSA rise to have Salvage radiation.

The increased rate of metastasis of about 25% after waiting for salvage radiation is pretty hard to swallow. Are doctors really aware of this major difference.

This result demands getting a decipher score to be able to have a chance at Progression free survival.

I’m adding that specific graph in case other people have not gone to your link.

It’s sort of scary to see such a difference in results.

Whether you call it adjuvant or Salvage. My 90-day post-op PSA was .19 and I began the process for Salvage radiation.

Surgery in August 2022 and radiation in March 2023. I had IMRT radiation over almost 8 weeks at Johns Hopkins.

I have read that 6 months is a good period of time following initial surgery to begin radiation treatment as it allows the prostate bed to heal.

Numbers: Post stop pathology confirmed Gleason 9 with epe. All else clear.

2 years following completion of Salvage radiation treatment (WPRT) see SPORRT trial and my upsa has been undetectable < .02 with my next test later this month.

Fortunately post-op I had excellent continence and the salvage treatment had little impact on that function. ED recovery paused during salvage treatment, whether from ADT or radiation or both. Can say I have had significant ED recovery over the last 3 years but not 100%.

Best wishes.

may i ask who your surgeon and RO were? and if you are happy with them. i used pavolich for surgery and talking to dr song for radiology.

Yes, you may.
Misop Han, MD performed my RP.

And Daniel Song, MD is my Radiation Oncologist.

And I highly recommend both.