Recurrence in pelvic lymph node

Phil,
Thank you so much. Yes, the earlier radiation was to the prostate bed only. Since you just completed what I'm about to begin, please let me know how you experienced the 25 sessions at Sloan, and any advice you have for me. I’m 78, and I have a full summer schedule of activities. Did you, for example, need to curtail some of your schedule due to fatigue?

Honestly, being retired with no kids or grandkids I AM my own schedule😉. Every day revolved around those treatments - wake up, mandatory BM, work out, go to Sloan (3hrs total with travel time), come home, eat dinner, TV and bed. My wife by my side the entire time - now THAT’s true love!
Yes, I was fatigued by the ADT/radiation, but when your life’s at stake you just do what you gotta do.
Phil

Fatigue is my biggest issue after all the ADT treatments. Been off of them 5 months now- still have afternoon fatigue. Could be my age of 76. Can’t grow sideburns yet so… I know my testosterone is still way low.

Absolutely. I am 4 months post ADT, 6 post SRT and still fatigued in the PM. My RO said lingering fatigue seems more noticeable in pelvic radiation patients.
Phil

Nice to know about Pelvic radiation effects- thanks

So why didnt my RO tell me about this as I have/had two pelvic lymph nodes affected. Wonder if the afternoon fatigue ever dissipates- this is getting old- want to go to car shows but I m too tired too. I have dukes of Hazard car and 73 Roadrunner B+ condition. Have to leave the last summer cars shows early= too fatigued .

The study I mentioned about full pelvic radiation was just published in Lancet in May 2025. Perhaps your RO didn’t know about it.

@heavyphil

Hi Guys, I am the wife of Joe, who has biochemical recurrence after 7 years of initial treatment: RP and prostate bed radiation: 7 weeks I think.

OK, so now PSA is detectable at 0.149 (no ADT after initial treatment.
My question: must make a choice here:
1)Kaiser, our provider, wants to radiate the pelvic bed, whether or not PSMA PET, shows any positivity.
2) But, Dr. Scholz, our second opinion go-to: says that's crazy, just do spot radiation as the PSA rises, and you'll be fine -- actually go for a cure. Radiation is the only way to try for a cure in either case.

My concern: salvage radiation is most affective when started at very low PSA: 0.2 TO 0,5 at the very highest and that's a stretch. I think I've read every study by now. BUT PSMA PET most likely will be negative at these early levels. Urologists are unanimous that you start salvage radiation anyway. Most likely PSMAPET is not able to pick up micrometastasis.

So, here's my dilemma, which road does Joe take? I'm inclined to go for broke and radiate the pelvic bed (it's been 7 yrs since the prostate), if we keep waiting around to hopefully find all the lesions and radiate them, we could be missing lots of microscopic metastasis.

@treesqueak
Hi Treesqueak, so this is NOT full pelvic radiation, but SPOT radiation, right?
This is what is feasible for patients who have already had salvage radiation to their prostate bed. But, if you read below, Kaiser wants to do a full pelvic radiation coverage. I am just not sure what to do.

@barblouise if Joe already had prostate bed radiation after his prostatectomy I don’t think he can have full pelvic radiation again. However, he can have his pelvic lymph nodes radiated since they did not target them previously.
I agree with all your points about spot treating with SBRT and also the management of micro metastases and possibly letting them spread even further. It is a real dilemma for sure!!
It does seem however, that at this point, he is going to need some form of ADT because let’s face it : His cancer has come back after surgery and radiation so you would have to think it’s pretty strong, right?
I think you need more than just two opinions on this, and although it might be a hassle, in the long run it will give you the best chance for making the best possible decision.
Phil