Need Radiotherapy guidance

Hey @zj69
I was sent off to the radiation oncologist when I hit .091.

We did a PSMA-PET scan before starting the radiation but nothing was found. One of the other members shared this chart with us showing what can statistically expected from the scan in reference to psa..it shows that only about 30% of those scanned at your psa level actually find the cancer location, yet, the PSA is telling you there's some bad stuff growing. I was comfortable taking the aggressive approach.

There are people in both camps. Some would suggest that the thing to do is wait till you get around 1.0 and then scan and make your decision then. We all have to do what we are comfortable with.

Sorry I couldn't be more helpful but at least you have a smidge of information you might not have had.
Best of luck to you!

ADT & RT recommended and initiated.
Sadly similar to your history, except my initial 90 day PSA was 0.19
I agree with web265 that there is research supporting earlier salvage tx. 0.2, and even lower.
Would ask for current PSMA PET. If there are any hits, they may be suitable for radiation tx. If not, good sign.
However the prostate bed and nearby lymph nodes might be harboring PCa, and whole pelvic radiation, or prostate fossa and pelvic lymph node radiation appear to be the standard of care.
Best to you.

@zj69, what did you and your cancer team decide as next treatment steps?

You said your pathology report said - "Gleason score of 3+5 and one pelvic node positive."

The question you may want to consider asking is, if I wait for my PSA to rise and image again, would it change my treatment decision...?

If the answer is no, then, consider going with your decision. If the answer is you want additional clinical information on where the PCa is before deciding.

The question is, would waiting cause harm. My sensing and my urologist agrees in my case, no, at low PSA numbers such as yours (and mine as you can see from my clinical history), waiting to get additional clinical data does not entail risk of the PCa getting out of control.. I was just below the threshold he and I had established, .5. to image. We agreed to wait for one more PSA test, it came back at .7 so it met our criteria, three or more consecutive increases and between .5-1.0.

If your decision is to treat now, understand you have systemic disease and monotherapy, a single ADT agent, may not be the answer. Do some homework on doublet and triplet therapy, given your pathology report, one of those may be a good decision.

If you and your medical team decide to do radiation, strongly discuss and consider not just the prostate bed but the entire PLN system. and how high up the treatment field will be. If you wait for additional imaging it may change the radiation treatment plan by providing specific sites where the treatment plan could include boosts and wider margins to those, but it should still treat the entire PLN system.

Kevin

Thanks, Kevin. Last week my PSA came with 0.28 my urologist suggested another PSA test in Jun. and PSMA PET Scan.

Hi Colleen,

I went to see Tony Finelli at Princess Margaret Cancer Center Toronto. he did my surgery in FEB 2022. Clinically it was T2, but the pathology report found EPE and one pelvic lymph node-positive. My PSA is now 0.28 after 14 months post-surgery.

it is now PT3aN1. He suggests doing PSMA PET SCAN in June before ADT + Radiation. I was only worrying when he said many got BONE metastasize.

Thanks

My urologist ordered PET PMSA at .20 referred & to radiation oncologist, started 1-2 year Eligard. PET scan clean, Completed radiation. PSA lower every test. PSA persist last read 0.059 Due for PSA couple weeks.

My journey was very disrupted/stalled as my urologist for surgery was removed from hospital practice with local office closed..

This may help in our discussions with your radiologist - https://www.prostatecancer.news/2021/05/new-guidelines-for-salvage-radiation.html

Like you I had reccurrence 3 years after RP. PSA slowly rising from 0.02 now at 0.31. I had pet/PSMA scan at PSA 0.22 a suspicious finding was noted in a lymph node,I was advised to follow with PSA tests and repeat pet/psma scan at 0.4. after doing much research I decided not to wait until 0.4 but repeated the scan at 0.26 which confirmed the previous suspicions with the infected lymph node. I will be starting 6 month eligard injection followed by radiotherapy 25 imrt/vmat to whole pelvis with additional sessions of SBRT to infected node.
I think it helps when adding the information from the pet scan as you can then receive targeted therapy to the relevant infected sites

Totally agree. Better to have the rifle rather than the shotgun approach when it comes to Salvage Radiation. The great uncertainty is whether the PET scan will pick up the cancer at a PSA of .220 or .260. Like you I was fortunate that the PET scan picked up my cancer when my
PSA was at .370