Anyone had salvage radiation therapy post-prostatectomy?

Jeff - what kind of radiation did you have (IMRT ?), or something else. Did they zap your lymph nodes also ? Did they use gold markers inside the body ?

I had 7 1/2 weeks of IMRT radiation. It was to the prostate bed so I am sure they did zap some lymph nodes during the process. They put tattoos on my stomach to be able to line me up for each treatment.

That was 12 years ago and I really didn’t understand enough to ask specifically what they were zapping. It is pretty standard to get the lymph nodes in that area since they are susceptible to reoccurrence.

According to my 'urology team' a PSMA PET scan is generally recommended for prostate cancer recurrence detection after radical prostatectomy when the post-salvage radiation therapy (sRT) PSA level is 0.2 ng/mL or higher. The effectiveness of PSMA PET scans increases with higher PSA levels, and many insurers will not reimburse the scan until this 0.2 ng/mL threshold is met, according to the American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology definition.

Had radical pros.back in the 2015 residue after 6 months of 0.45 complete radioterapy than.Did 70gy
prostate bed. Fine for some 8 years started creeping up last 2-3 years slowly from 0.09 at 2022 to 0.53 now.Waiting for the pet/ct next month. Obviously I'm bit late with hormone hell coming, but there is no alternative i guess. My GS was 6
3+3 no extension out of the capsule..any suggestions would be appreciated.

I’m not a doctor, but it sounds like you’ve done a lot to stay on top of this. A slow PSA rise after so many years can be worrying, but waiting for the PET/CT is the right next step—it’ll give a clearer picture before making decisions. With a Gleason 6 and long remission, you still have good factors on your side. Hormone therapy is tough, but there are ways to manage side effects, and your doctor will help tailor the approach. Stay strong—you’ve handled this well so far.

I reckon you got nothing to worry about, did all the treat of 70gy 7 weeks and no issues to worry about..maybe little urinary issues, but they go away after few weeks.

I’m going through that now. I asked about lymph nodes and my RO said that they would be zapping everything including lymph nodes even though all 19 nodes during my prostatectomy were negative for cancer.

I went BCR in 2 years and started salvage at .24. I recently had a second opinion at a CCC with a Genito Urologist. He stated he didn't find me interesting as he only treats stage 4 cancer and wouldn't take me on as a patient at this time. He also stated to wait until my PSA hits 2.0, not .2 and they could find it then. At .24 I started Lupron and 3 weeks later salvage radiation. I agree with Jeff that your level is too early for scans as they more than likely won't show any lesions. PSA 2.0 seemed controversial to some in the room. Many rush to ADT at .2, myself included, but if I bounce again to BCR I will rethink the whole thing. Currently I am 2 months post 6 months of ADT treatment, 6 months post salvage radiation with my T@ 208 and PSA undetectable. I switched to Orgovyx after 3 months due to Anemia while on Lupron. After 3 months on Orgovyx my anemia was gone and LDL started to rise some. I had a hard time with radiation as the practice I went to wasn't interested in any prophylactic measure such as SpaceOre or Oxybutynin for bladder spaz. As a result my radiation truly sucked, blew up twice on the table in one session and now have Radiation proctitis. It sucks and I need to get in to see someone. I would suggest to anyone doing radiation to get Space Ore gel or similar and Oxybutynin for bladder urgency. If they won't do it, run don't walk away and find another radiologist. All this stuff is scary but a good provider will tee you up for success but nothing is guaranteed. Best wishes on your journey.

Wow, I can’t believe a GU oncologist would tell you that you don’t need to do anything until your PSA hits 2 After having surgery. The medical community has guidelines that say once it hits .2 that you absolutely need to have salvage radiation. Of course, if you did not have surgery, then you wait till your PSA hits 2 over the minimum it ever went to. That’s very different from after you had surgery.

It’s good to hear that you had the right treatment. After I had salvage radiation, they did not give me ADT. They didn’t know I had BRCA2 at that time, Almost definitely would’ve been different if they did. Even with the genetic problem, it took 2 1/2 years before my PSA started rising after salvage radiation, So ADT was really not necessary,

Sorry to hear about all your proctitis issues. As I mentioned before, I had absolutely no symptoms at all after radiation and most people I’ve heard from had very few side effects from it.

If you had salvage radiation, that means you’d already had a prostatectomy, So it doesn’t do any good to put in a barrier since the prostate is gone. They would not do it under those conditions.

I had undetectable PSA (< 0.1) for ten years after my radical prostatectomy. Then this past June, my PSA came in at 0.11, and three months later it is still 0.11 (and an ultra-sensitive test came in at 0.096). Because I had a small, palpable nodule in the prostatic fossa, my urologist ordered a PET PSMA scan in June. Even though my PSA was low for a PET scan, the nodule lit up like a Christmas tree on the scan (SUV =13). A follow-up MRI with contrast confirmed the lesion/nodule with evidence supporting a local recurrence. No scanning evidence of metastatic disease. I’m starting EBRT tomorrow on the nodule and pelvic lymph nodes.

Anyway, has anyone done a digital rectal exam? If something is found, that would likely put you in the fast lane for a PET scan.

Ten+ years until recurrence, and very low PSA doubling time are in your favor for slow disease progression, if you do have a recurrence. I would push to get a PET scan. If they can pinpoint the recurrence, then any radiation treatment will be more of a precision strike.

There are studies that have indicated that early salvage radiation (before PSA is 0.2) yields better outcomes. But with that said, I like you, have been concerned about over treatment for recurrence. With my PSA being low, I allowed myself the time to weigh all the risks and benefits of immediate vs delayed salvage therapy, and different treatment options. I feel that I am making the right choice to move forward with radiation therapy now.

Best wishes. The sub 0.2 PSA without scanning or digital evidence of a recurrence is a bit of a gray zone.