My PSA climbed 02, .04, .07 .15 .21 had a RP 2 yrs ago PSMA negative ?

At a PSA of 0.2, a PSMA PET scan will miss 2/3 of prostate cancers. (See attached graphic.)

Did you have a PSMA PET scan prior to your prostatectomy? If so, what were the results?

Dr. Kwon (of Mayo Clinic) indicated that only 1/3 of men who have recurrence following prostatectomy have recurrence only in the prostate bed, and that they should not get salvage radiation there unless they’re absolutely certain of the location of recurrence. He says to first confirm where the recurrence is. (See Dr. Kwon’s presentation about recurrence: https://youtu.be/Q2joD360_pI)

@brianjarvis 😳 How would this align with the general statistics on SRT?

@topf Not quite sure what you’re asking?

But, as you can see from
Dr. Kwon’s presentation, he’s talking about salvage treatment (i.e., recurrence).

You are facing salvage radiation now. If the PSA hits.2 after an RP then that is the standard of care.

It is pretty normal that no metastasis are found so they radiate the prostate bed and lymph nodes.

The American society of clinical oncology recommendations are below

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/

@brianjarvis What Meant is that if SRT to the prostate bed has bcrfs rates of 80%+ in nomograms, how can it be that 2/3 of patients treated have cancer outside the prostate bed?

@topf

Dear Topf,
There are so many new "suggestions" and theories that IMHO it is best to stick with "old and proven" methods. That "new way of thinking" is too scary for my comfort since if there IS recurrence in a prostate bed and one misses that PSA 0.2 level (or lower for aggressive cancer) than one risks distant metastatic cancer developing !!!
I do not understand Kwan at all. Yes- if cancer already is metastatic (in other parts of a body) than irradiating pelvic area makes no sense but if it IS there than it is great advantage to eradicate is while it is still "there" and at PSA level 0.2 or lower !

@topf For each of those cases where salvage radiation treatment had been administered to the prostate bed, had it already been confirmed that’s where the recurrence was? It’s important to know that when interpreting the data.

@surftohealth88 I was under the impression that if you radiate the prostate bed and there is cancer some place else that you would know from a psa test. He also says that salvage surgery after radiation is safe, which was also new to me.

@brianjarvis I realized that he is talking about his own shop. I assume that he gets mainly high-risk cases to start with.

@topf Perhaps so. But when trying to extrapolate a population of cases to a specific case - me or you - that piece of data is important to know.