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Anyone had salvage radiation therapy post-prostatectomy?
Prostate Cancer | Last Active: Sep 24 4:30pm | Replies (67)Comment receiving replies
Similar situation, undetectable for eight years, now 10 yrs post robotic removal and psa has crept up to .5. Two PSMA PET scans, nothing detected. Studies show PET scan detection rates were 38% (PSA 0.2-0.5 ng/mL), 57% (PSA 0.5-0.9 ng/mL), 84% (PSA 1.0-1.9 ng/mL), 86% (PSA 2.0-4.9 ng/mL), and 97% (PSA ≥ 5.0). JAMA Oncol. 2019;5(6):856-863. I agree with my uro's suggestion to hold off radiation with blood test every 6 months. He believes recurrence is likely in the prostate bed and a targeted approach is best vs radiating the entire bed and risking collateral damage. I believe (purely anecdotal) those of us "lucky" enough to experience BCR many years after surgery are in a different position than those who experience BCR < 3 yrs post surgery and that watchful waiting is a prudent course.
Replies to "Similar situation, undetectable for eight years, now 10 yrs post robotic removal and psa has crept..."
You’re not wrong about BCR of 3+ years following surgery. The tables in Dr. Walsh’s book show that men whose recurrence is >3 years after surgery have much better odds of not dying from PCa at 10 and 15 years than those who have recurrence < 3 years after surgery, regardless of Gleason score and PSA doubling time. But if your Gleason score is < 8 and DT is greater than 3 months, your odds of survival improve even more, according to the tables.
I’ve said this before—from all my investigations and readings, it seems that if you are experiencing BCR and are in the intermediate risk category that there is no real physician consensus on when and how to treatment.
I agree with Jeff that second (and third opinions) are a very good idea. And in agreement with Jeff, there is a good body of literature that indicates that early salvage RT yields better outcomes. And that early salvage is the route I am taking.
But also, in the intermediate risk category, I think it is important to weigh one’s specific circumstances in any treatment decisions. The first RO that I consulting with wanted to treat with RT and short term ADT based on the SPPORT trial results. However, because I have a palpable, local lesion, I would have been disqualified from that trial. The SPPORT trial was valid, but how it applied to me was not clear. When I brought that up with the RO, he as much admitted that I had a valid point and that he was extrapolating the results of the SPPORT study to my specific case. I moved on to a different RO.
Lastly, to me, quality of life is an important factor, or at least shouldn’t be brushed aside/minimized, as seems to happen with many treatment recommendations, especially in the intermediate risk category.
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ASCO, which set some of the standards for handling prostate cancer doesn’t agree with your doctor at all. I think you should find a second opinion at a center of excellence because waiting is not to your benefit.
From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL: Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%). Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL: Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL: Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.
This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/