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Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?
Prostate Cancer | Last Active: 2 days ago | Replies (100)Comment receiving replies
I find this discussion thread very relevant to my situation, as I am currently on BCR watch a year after my prostatectomy. My PSA remains undetectable, but I recognize that I have several significant adverse risk factors for recurrence, including pT3b disease with seminal vesicle invasion, extracapsular extension, lymphovascular and perineural invasion, and a high-risk Decipher score of 0.75. My preoperative PSA was also 14.5 ng/mL. On the favorable side, my surgical margins were negative.
Given this risk profile, my current thinking is to consider early—or even ultra-early—salvage radiation therapy if my PSA begins to rise, perhaps before it reaches 0.1 or 0.2, even if the recurrence is not yet visible on a PSMA PET scan. I believe this is consistent with 2026 NCCN and 2024 AUA/ASTRO/SUO guidelines.
However, I know that prominent oncologists such as Dr. Kwon and Dr. Scholz seem to favor waiting until recurrent disease is visible on a scan. I am not sure whether they would recommend the same approach for a patient with my particular combination of pathological and genomic risk factors.
Each approach has potential advantages and disadvantages. I am hoping that rapid advances in increasingly sensitive PSMA PET imaging will eventually make this distinction somewhat moot.
Any thoughts?
Replies to "@jeffmarc I find this discussion thread very relevant to my situation, as I am currently on..."
@soli I guess the PSA velocity is the only way you can make that decision; speed usually indicates BCR.
As for Dr Kwon, I am not a big fan of waiting to see flames coming out of the second story windows before I call the Fire Dept…where there’s even the smell of smoke, there’s fire.
Phil
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@soli
As you bring up, some doctors will do adjuvant radiation Others want to wait. They look at where your PSA is and how quickly it is rising. Some people can go a long time before their PSA starts to rise. As far as when to do adjuvant radiation, this is one of the guidelines for it. As you can see you qualify for at least three of the guidelines. The real question is, Is your PSA really rising at all or is it stable?.
Adjuvant radiation
Dr. Efstathiou concluded as follows:
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur
Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html