Connect
← Return to Low, But Rising PSA--Wait for Imaging or Act Now?
Discussion
Low, But Rising PSA--Wait for Imaging or Act Now?
Prostate Cancer | Last Active: May 11 3:56pm | Replies (72)Comment receiving replies
@jeffmarc
Thats your choice, I don’t think I would radiate my pelvic area unless I know there is cancer to kill. There is a good possibility of damaging the bladder and colon. This is from Sloan Kettering:
“Radiation therapy can cause permanent urinary and bowel changes. Many people don’t notice any changes or have any symptoms. However, some people have late side effects.
Late side effects may be similar to the ones you had during treatment. There’s a very small chance you may develop other side effects. For example:
The opening of your bladder may become narrower.
You may lose your ability to control your bladder.
You may have blood in your urine.
You may have bleeding from your rectum.
Your rectum may be injured.
These side effects are rare. They may come and go over time or be persistent and chronic. Your healthcare team will help you manage them.” That’s great you did not have any long term problems but the radiation affects people differently. Just because you did not have any problems does not mean the next person will also not have any problems. Yes I am new to this site but have been on the American Cancer Society site for 11 yrs. I don’t know what you mean a large number will need extra radiation but on the ACS site many who posted that had surgery did not need extra radiation in the prostate bed. To each his own but 65% odds of the cancer not being there and let’s just radiate it anyway is iffy in my book. I will wait for it to show up in PET scan then spot radiate it. My body, my choice.
Dave 3+4
Replies to "@jeffmarc Thats your choice, I don’t think I would radiate my pelvic area unless I know..."
@clevelandguy
Between 20 and 40% of the people that have prostatectomy have a reoccurrence. In the majority of those cases, no metastasis is found.
The American Society of clinical oncologist does not agree with you.
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/
@clevelandguy NO, it’s a 65% chance that cancer IS there…Even Dr Kwon, whom I do not agree with, says that SRT fails in ONE THIRD of all cases - so roughly 35%.
So the odds of cancer being in the pelvis are pretty high…
Phil
@clevelandguy That is why everyone should get the Prostox test before prostate radiation to see if they fall into the 75% or 7% probability group of having late radiation side effects. Most of what determines who has bad aftereffects is genetics. A lot of the rest is bad targeting. All medical disclosures are written for lawyers by lawyers since non-disclosure even of a 1 in 10000 chance is opening them up for lawsuits (why a ladder is covered with warning stickers now).
Connect
@clevelandguy
This does answer that question for advanced cases, waiting is not the answer
Life expectancy for prostate cancer patients that ignore treatment
https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/168250-natural-history-of-untreated-prostate-cancer-a-comprehensive-review-of-long-term-progression-patterns-and-survival-outcomes-beyond-the-abstract.html
Grade Group 1 (Gleason 6) disease showed metastatic progression rates below 5% over 15–20 years and prostate cancer-specific mortality under 5% at two decades. These are the patients for whom active surveillance was designed, and this review provides robust quantitative backing for that approach. Conversely, Grade Groups 4–5 (Gleason 8–10) were uniformly lethal in conservatively managed cohorts: median time to metastasis was 3–5 years for Gleason 8 and just 1–3 years for Gleason 9–10, underscoring the urgency of early intervention for these men.
The intermediate grades deserve particular attention. The distinction between Gleason 3+4 and 4+3—both classified as "Grade Group 2–3" and both often lumped together as "intermediate risk"—carries meaningful clinical weight. Our synthesis found roughly 2–3 fold differences in 15-year progression rates (35% vs. 55%) and hazard ratios for cancer-specific death of 2.1–3.2 between these two patterns. Clinicians and patients should not treat these as equivalent.