← Return to The right time to start radiation post RP with an increasing PSA?

Discussion
Comment receiving replies
Profile picture for Jeff Marchi @jeffmarc

After a prostatectomy, they usually want to do Salvage radiation when the PSA hits .2.

That is exactly what happened to me And many other people I know of. I had the RP at 62. When My PSA hit .2 3.5 years later they gave me a six month Lupron shot and two months later I started 8+ Weeks of salvage radiation. They do it in a shorter time now, but they give you more radiation in each session.

Here is the recommendation from the standards group, I’ve included a link to the actual article so you can read the whole thing.

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/

Jump to this post


Replies to "After a prostatectomy, they usually want to do Salvage radiation when the PSA hits .2. That..."

@jeffmarc with more aggressive features as my partner has, MO recommended to us yesterday at our first appointment to have him start Zytiga and Orogyx straight away and most likely 7 weeks of radiation. His PSA yesterday was 0.076 up from a month ago 0.072.

Would he want to wait a bit or start straight away because of the aggressive features his PCa has? Thank you