What tests and scans were ordered before you had your salvage RT ?

@pamperme
Hi @pamperme - thanks for listing all tests.

I hope that your IMRT is uneventful and that you are tolerating sessions well 🍀.

Wishing you the best of luck and complete and forever eradication of PC ✨ !

I wish you the best for salvage radiation to eradicate your pc forever too. I am 5 months into ADT with Orgovyx and have completed 15 sessions of radiation. I have no effects from the radiation except being tired which could be the adt. My PSA only reached .15 but with the questionable margins and they did a decipher test (they should have done after RP) it was .92 which is extremely high for a Gleason 7 (3 4). Both URMC and Sloane Kettering recommended radiation. Sloane offered 5 sessions of SBRT which is new for this but is becoming more used. It would be nice to only going for 5 sessions.
My adt and radiation end on June 18. The adt biggest problem is handling my emotional side. I also have brain fog, weakness and tired. I hope I do not have a reoccurrence having to go back on it. It definitely changes me mentally. Good luck and best wishes
Timmy

Hey surf. You pretty much know my history but here goes anyway. I did not have surgery but had IMRT to prostate as primary along with ADT/ARSI. Once PSA started to climb again, DexA, MRI, PSMA PET, CT, CMP, PSA, total T. Focusing on ALP and liver enzymes on the CMP. SBRT to begin the Tuesday after Memorial Day. Oncology discussion of systemic treatment on June 2. Give hubby my best! You guys got this. 👍🙏👍

@pamperme
Thanks Timmy so much for finding time to give me additional details and an update about your treatment 💗 My husband is in very similar situation, one iffy margin, Decipher 1 (the highest that exists) and his pathology after RP was updated from 4+3 to 4+5 😔. Cribriform and IDC on top of it all... Our "doctor team" is not proactive (even though my husband is treated in a big cancer center of excellence in the Bay Area, CA ) so we have to fight for every single step taken. His uPSA climbed from less than 0.014 post op to 0.136 now (9 mos post op) and they do not see it as "urgent" which blows my mind !!! I feel like I live in some parallel universe where high risk BCR is "nothing to worry about" (??) Every single study shows that treatment should start at 0.25 the latest and his doubling time is less than a month ! We finally managed to get orders for some tests and some we did on our own. PSMA was scheduled for June 8th which would possibly push my husbands PSA in 0.5 territory 😵 so we had to call around and make app. in different hospital that had a sooner opening : (((. All in all, thanks again for all the details since we have to basically make my husband's sRT plan and protocol by ourselves : (((.

Sending healing vibes your way : )) !!! You are half way done and are in very competent and caring hands 👍 - just little bit more and you will be done with this all : )))) ! Wishing you all the best <3

@mjp0512
Hey Mjp 🐥 !
Thanks for listing all of your tests, it is very much appreciated <3.
I am so glad to hear that your treatment plan is almost finalized and that RT is ready to roll : ))) - May 26th 👍, I will be thinking about you and sending healing vibes : ))) !
Will you have SBRT every day ? How many sessions ? I really hope that once that one lesion is zapped that all will fall into place and that no further treatment will ever be needed 🍀✨
My hubby is thanking you very much and sending best regards and best wishes back ! 🙂 Thanks for your words of encouragement 💗

surftohealth:
keep advocating and pushing. Having cancer should never be taken lightly

@surftohealth88 - Easy go this time around, only 2 sessions. Tuesday and Thursday and done!

@surftohealth88 As soon as that PSMA is done and read ( negative!) get him on the Orgovyx/Nubeqa(?)
ASAP. You’ll be able to put the brakes on right away.
Phil

@surftohealth88 I had RP surgery 11/11/24 and my Gleason also went from 4+3 to 4+5. PSA was at 0.02 after 8 months, and 0.04 after 11 months. Even though it was still low we decided to move ahead with radiation because it was trending the wrong direction. I had a single Lupron shot in October 2-25 and 39 radiation sessions from 12/8/25 to 2/4/26. As of 2/18 my PSA was <0.01. My only side effects were fatigue from the radiation and hot flashes from the Lupron. I'm getting my energy back but the hot flashes continue. I'm feeling good about the process so far. My next appointment with radiation oncology is in early July.

When my salvage radiation was done in 2019 by Dr Sean P. Collins (one of the best) at Georgetown Medstar it was done without what's available now. Still got a great result with recurrence later only outside of the area he treated

Today with new scans authorized (from AI on the subject)

Before proceeding with salvage radiation, a comprehensive workup is used to determine exactly where recurrent cancer is located. PSMA PET scans (which map out a protein on cancer cells) and multiparametric MRI (which details soft tissues in the pelvis) are the primary imaging tests utilized.

These tests work together to pinpoint the location of the disease, guiding your radiation oncologist on where to target treatment.

1. PSMA PET Scans

Prostate-Specific Membrane Antigen (PSMA) PET scans have become the gold standard for detecting recurrent prostate cancer.

• How it works: A radioactive tracer is injected into the bloodstream, which then attaches specifically to PSMA proteins (which are highly overexpressed on prostate cancer cells).

• Role in salvage therapy: It detects whether the cancer is confined to the prostate bed, has spread to nearby pelvic lymph nodes, or has metastasized elsewhere in the body.

• Advantage: It is highly sensitive, meaning it can detect tiny clusters of cancer cells even when PSA levels are still very low.

2. Multiparametric MRI (mpMRI)

While PSMA PET is exceptional at finding cancer anywhere in the body, MRI provides unmatched anatomical detail of the local prostate bed and surrounding pelvic organs.

• How it works: Uses strong magnets and radio waves to create highly detailed images of the soft tissues.

• Role in salvage therapy: It maps out the exact anatomy of the area where the prostate used to be (the prostatic fossa) and nearby structures, helping radiation oncologists avoid vital organs while focusing the radiation beam.

In many modern centers, these two technologies are merged.

• PSMA PET/CT: The standard setup where the PET scan (functional tracking of the cancer) is combined with a traditional CT scan (anatomical mapping).

• PSMA PET/MRI: A hybrid scanner that combines the functional tracking of PSMA PET directly with the highly detailed soft-tissue anatomy of an MRI. This allows clinicians to co-localize suspicious PET uptake with precise MRI tissue characteristics without having to undergo two separate scans.

Accompanying Tests

Before determining if salvage radiation is the right path, other standard clinical tests and labs are usually performed:

• PSA Blood Test: A continually rising PSA level (biochemical recurrence) is often the initial trigger that prompts these scans.

• Testosterone Level Test: Checked to ensure hypogonadism (low testosterone) is not masking the true nature of your PSA numbers.

• Digital Rectal Exam (DRE): Used to physically feel the area where the prostate used to be for any palpable nodules or irregularities.
GOOD LUCK!!!!