Anyone had salvage radiation therapy post-prostatectomy?

Avoid if possible at any cost. PSA rise from .08 to .13 is not a double and this is after 2 years. (Repetitive doubling over 6 month intervals is a red flag). Post-surgery radiation almost destroyed me. Incontinence, Urethra stricture, Incessant bleeding bladder, anemia, multiple ER and hospitalizations and procedures until finding a treatment that worked. Granted there are newer and more targeted radiation than 7 years ago, but still - Don’t just do something, stand there.

@lsk1000
What happened to you after radiation is extremely unusual. The vast majority of people that have salvage radiation have minor or no issues, Proctitis for some, Some diarrhea for others. Some have fatigue, but it’s not common either. I had eight weeks of salvage radiation and had no side effects at all. After about six years, I started having some incontinence problems, but I’ve had surgery and radiation so I can’t blame it on one thing.

It seems the people that have 20 or so weeks of salvage radiation are the ones that have the problems. Those that get 35 or 40 weeks of salvage radiation are getting lower doses and it seems to cause fewer side effects.

I’m currently on BCR watch after prostate surgery last September. If and when I have a recurrence, I’ll need salvage radiation, so I’ve been doing a lot of reading and recently consulted with Dr. Amar Kishan, a leading radiation oncologist at UCLA.

He’s doing important work on improving the precision of radiation delivery, including real-time adjustments during treatment—such as pausing radiation if nearby organs move beyond a preset limit, and reducing planning margins. The goal is to better protect surrounding organs and reduce side effects.

One key takeaway from my discussion with him is that radiation tends to worsen pre-existing urinary symptoms, such as urgency, frequency, and post-surgical incontinence—especially in patients like me who already have these issues. Because of that, SBRT (which is currently only available post-prostatectomy as part of a clinical trial for salvage radiation) may carry a higher risk of side effects for some of us compared with conventional salvage radiation given over 35–40 treatments.

Bottom line: side effects depend heavily on the experience of the treatment team, the precision of radiation delivery, and a patient’s pre-existing urinary (or other) issues.

@soli
I'm simply replying to the most recent contribution to this thread, but it has been on my mind in deciding on any radiation therapy. From the MiraDx company:

"PROSTOX test can report the risk of late GU radiation toxicity from stereotactic body (SBRT) or conventionally fractionated (CFRT) radiation therapy, based on a patient's mirSNP signature. The assays provide a high or low risk score that may be useful in choosing the safest course of treatment, to avoid toxicity."

"High-grade GU (genitourinary) toxicity after SBRT can occur years (5 to 10) after radiation treatment. Cumulative Incidence: Grade 2 or higher GU toxicity has been reported as 16.3% by year 5 and 19.2% by year 10.
Types of Toxicity: Common late toxicities include worsening or new urinary incontinence, hematuria, and urinary urgency." (AI or search results)

Is this ever offered to patients like us? I have yet to have this type of discussion with a Radiation Oncologist.

Even though I have no BCR at this time, I saw Dr. Kishan primarily to get a second opinion on my decision not to pursue adjuvant radiation now, but instead to be prepared for salvage radiation if and when my PSA rises to around 0.2. He agreed with this approach and noted that imaging scans might be useful at that point if the cancer becomes detectable.

I also asked him about the PROSTOX test, and he ordered it on the spot. A nurse collected five cheek swabs from each side of my mouth. The results may help guide future decision-making by identifying which treatments I might tolerate better—or should potentially avoid—if and when treatment becomes necessary.

@soli

Thanks Soli for sharing this info.
Did Dr. Kishan mention use of "spacer" or gold bead markers in case that you ever need RT ? I am asking since at our consult with a RO only markers were mentioned.
Thanks so much in advance.

Hi @surftohealth88

We didn’t discuss spacer with Dr Amar Kishan since I believe that applies when the prostate is being radiated. In my case, if and when it is needed, they will be radiating the “prostate bed”. That is why - I believe - the subject of spacer didn’t come up.

@soli
Thanks for explanation Soli and for additional information : ).

I would like to have "ALL" men chime into this response. I would like to know if this gentleman, and any/all other gentleman who had a successful RP surgery with documented "tumor confined to prostate, without Extraprostatic Extension (EPE) or surgical margins," later had biochemical recurrence of their cancer?
This gentleman's story is amazing to me that as a 53 year old man ( he is 68 and had the RP 15 years ago), he had the best chance to survive, disease free...UNLESS his surgical report said that he had EPE, surgical margins, and maybe seminal vesicle invasion.
I flat-out do not understand "how/why" men who had successful, tumor-contained-to-prostate" RP's without EPE and surgical margins, are coming back 10-15 years later with biochemical recurrence and elevating PSA levels. If there are any physicians on this blog, please contribute to this perplexing reality. And finally...
I ask this gentleman: Did you in fact have EPE and surgical margins, or was your surgery "clean" without EPE and surgical margins? Thank you

@rlpostrp
This may give you some information about this issue

Kwon and Moyad agree to this. Seeds for metastasis were already there when surgery was done, waiting to grow.