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Anyone had salvage radiation therapy post-prostatectomy?

Posted by mmmvegas @mmmvegas, Mar 15, 2025

I had radical prostatectomy surgery back in the summer of 2011 and have recently experienced rising PSA levels. My PSA levels were never completely undetectable but have rises from an average of .08 to my most recent of .13 in the last 2 years. My urologist referred me to their radiation oncologist and he said that I was early for salvage radiation therapy last summer. I am hesitant to have the radiation earlier than necessary (if it is even necessary) as I am worried about side effects. I have no symptoms related to my prostatectormy and am nervous about the possibilities of having something to deal with after radiation. I am 68 years old.

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wwsmith | @wwsmith | Feb 4 4:40pm
In reply to @rlpostrp "I would like to have "ALL" men chime into this response. I would like to know..." + (show)
Profile picture for rlpostrp @rlpostrp

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

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@rlpostrp EPE and positive surgical margins are large phenomena, easily observable by the naked eye. Cancer cells are microscopic and the first to escape the prostate gland will leave no noticeable indication that they have done so. That is why it is impossible at this point in time to know whether any particular surgery was "clean" or not.

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lyricw | @lyricw | Feb 4 5:39pm

Keon mentioned cells escaped prior to prostatectomy. Would radiation be a better choice for already escaped cells? I believe 10-15 year success rate is similar for RARP & radiation.

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surftohealth88 | @surftohealth88 | Feb 4 6:19pm

I would just like to add the fact that healthy prostate cells that stay behind are also just that - prostate cells. They can and do endure accumulation of mutations and become cancerous over time.

That is why we decided not to do any focal therapy to begin with - tissue that is left behind can become cancerous over time.

Also, cancer cells that escape not necessarily stay in proximity, especially over time they can end up in lungs etc. Since initial radiation is limited to pelvic area not all cancer cells are "covered" with that treatment either.

Bottom line - everybody can have BCR, no matter gleason or treatment choice. It is just that with some features such as EPE or positive margins and higher gleason BCR happens sooner and has higher probability to happen.

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heavyphil | @heavyphil | Feb 5 10:22am
In reply to @rlpostrp "I would like to have "ALL" men chime into this response. I would like to know..." + (show)
Profile picture for rlpostrp @rlpostrp

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

Jump to this post

@rlpostrp Well, that is what all the ‘experts’ like Dr Kwon et al are talking about at all these seminars.
If your initial treatment was successful and 15 years later your PSA is rising, is it really BCR? If a PSMA is negative do you begin SRT anyway…or wait until you see something? And what if you wait too long??
It is truly exasperating!!
Phil

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