Connect
← Return to Recurrence Post RALP: Did a second opinion change your plan?
Discussion
Recurrence Post RALP: Did a second opinion change your plan?
Prostate Cancer | Last Active: Apr 11 10:39am | Replies (58)Comment receiving replies
@jeffmarc — thanks, that was helpful.
Just to clarify, I’ve already had RALP, so my question is really about **timing of salvage**, not adjuvant therapy.
At this point, with a rising PSA, I’m assuming I’m in early recurrence. The questions I’m trying to think through are:
* If PSMA PET is negative, should I proceed with early salvage radiation rather than wait?
* How should field selection be approached (prostate bed vs pelvic nodes)?
* What role and duration of ADT makes sense in this setting?
It doesn’t seem like there’s a single clear answer. On one hand, treating early may offer the best chance of control given my pathology. On the other, there’s the risk of treating more broadly without knowing exactly where disease is.
Balancing that uncertainty—especially with negative imaging—is what I’m trying to sort through. That’s also why I’m considering a second opinion, just to make sure I’m approaching this correctly.
Appreciate any additional thoughts.
Replies to "@jeffmarc — thanks, that was helpful. Just to clarify, I’ve already had RALP, so my question..."
@dhasper
Hi,
With salvage radiation they would need to find the cancer then kill it or do a genralized wide swath of radiation in what area? I think your doctor team is correct to wait until the cancer shows up on a PMSA PET scan. Taking ADT is usually done before and after radiation to weaken the cancer before they zap it.
Dave 3+4
Connect
@dhasper
I just wish there was an answer from the medical community about this combination of aggressive issues.
When somebody has RP and then has BCR What’s next is based on the original aggressiveness of their cancer. With a Gleason nine and a combination of other issues 24 to 36 months of ADT is called for frequently. They would also want an ARPI included. With a 4+3 24 months might make more sense. You really need to speak to an Oncologist, Preferably a GU oncologist to get this treated Optimally. If you were to come to an ancan.org Meeting they would recommend you be on ADT plus an ARSI, based on what the Sstandard of care calls for in this situation.
The thing is this reoccurrence is happening pretty quickly. While .17 doesn’t sound real high. It came very Shortly after surgery. You could wait and see if the PSA continues to rise. I would want monthly tests at this point. Considering that they want you to have SRT at .2, if you can’t see anything on the PET scan. You’re probably gonna hit that in another month or two and SRT makes the most sense, it can hit the area where the IDC-P and cribriform was centered, the prostate bed.
I might be a good idea to get a second opinion. Having more than one doctor look at this can give you some comfort that the right thing is being done.