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

@topf

"Safe" maybe but mostly impossible and extremely rarely done. Also, if you have RP after RT permanent incontinence and ED are almost guaranteed.

I personally stick with well known and accepted studies and do not rely my decisions on "exotic" protocols. It is enough discord in "standard" of care to begin with : /

Salvage radiation is done with CURATIVE intent when it is done in pelvic area. If patient indeed had BCR in that area than it can provide cure and/or long lasting remission.

I do not think that just because micro mets are perhaps in a spine for some patients that 1/3 of patients who DO have cancer in pelvic area should risk NOT having possible cure (???? ) and/or 10 year remission ! Those that have mets in other areas can not have "curative" salvage since cancer spread throughout the body.

If PSA continues to rise than it is somewhere else but person at least tried. One third is not small % ! Many medication research trails would be happy to have 33% better results than placebo group ! They need to be better by 10-20% than placebo.

@topf
About 40% of the prostate is left after radiation.. Not all doctors will do the salvage surgery, but there are some that specialize in it.

@jeffmarc

The whole prostate become one thick mess that is hard to peal from urethra and remove. It is very rarely done - we never had here patient who went through that procedure - do you know of any , maybe there were some before I came here ? I know about results ( permanent incontinence and ED) because I read about it in some papers. It is very complex and high risk procedure since other tissues around are also damaged by radiation and surgery can cause serious scaring, damage to rectum and non-healing wounds, etc.

@topf A lot of them do - that’s why 30% of SRT to the prostate bed only fails. You need to treat the pelvic lymph nodes as well.
Dr Kwon has a somewhat different approach than most: he wants to SEE cancer on scans before he treats.
IMHO, by the time you ‘see’ the 8-10 million cells that form an actual tumor, or mass, how many microscopic clumps are floating around elsewhere??
I think he’ll probably have to put together some kind of study where one group of men are given SRT to the bed and nodes, and another is treated only when metastases are visible on PET scans. Survival rates could then be compared.
Following the Estradiol argument made by Dr Wasserman, you want to keep the absolute number of circulating PCa cells low; both for metastasis and castrate resistance. I cannot see how waiting for visible tumors accomplishes either goal.
Phil

My oncologist said they look for the rate of increase in PSA rather than a “red flag” number. If the rate of increase warrants, they will follow-up with additional treatment. However, each individual is different, and it might not apply to you. I might ask the rate increase question, however. Best of all to you on your journey…

I'm going to try and make a long story short. My wife was diagnosed with Cancer in 1994. While she was under treatment we got to know the Chief of Radiation Oncology for NW Ohio.
When I had to have my Rad Pros in 1995 my spa started climbing after a year. Believe it was 2.
My Urologist didn't want to do anything and rattled on about quality of life etc.
At one of my wife's treatments her chief Oncologist asked how I was doing as he knew about the PC.
When I told him my psa was climbing he suggested salvage radiaton of which I elected to do.
My urologist was so incensed that he would treat one of HIS patients he went to the Chifs practice and confronted him face to face.
After that I dumped my Urologist.
I'ts been 30 years since my Salvage Radiation. I'm 70yo now. I firmly believe that had i NOT gotten Salvage Radiation I wouldn't be her now.

@heavyphil
Dr. Kwon might’ve picked up that idea about waiting for metastasis to show up from Dr. Mark Scholz. He promoted the same thing in the PCRI conferences. Claims it works much better and he just keeps track of the people to see if they have Metastasis show up.

@denkea
This sort of shows why urologist should not be involved when the cancer comes back. The American Society of clinical oncology says that you should have salvage radiation at .2 and at .5 you should also have ADT if you waited.

That urologist apparently never kept up with standards of care. You really got lucky having a radiation oncologist you could work with directly.

One of the doctors in the ancan.org weekly advanced prostate cancer meetings, was treated by a urologist who ignored his rising PSA. By the time he realized that he was being neglected, he had a Gleason nine and metastasis spread. Fortunately, he was able to get it treated and is still doing OK in his mid 80s. Even a doctor can be misled by urologists that don’t keep up.

@surftohealth88
Not really heard much about salvage surgery.

Looking into it, I see the numbers are not great, as you mention.

When I looked into it, I noticed a wide range percentages of problems with ED and incontinent. I wonder if finding a surgeon that is really experienced in doing it can make a difference.

@heavyphil Yes, when no radiation has yet been used, waiting to radiate recurrent cancer only when first visible on PET scans will certainly allow cancer to spread more easily and greatly decrease the chance of a cure (NED after 5 years). I doubt that we will see other oncologists agreeing with Dr. Kwon's approach on this.