3 years negligible after RP surgery then rapid rise

3 1/2 years after my surgery, the cancer came back. I had salvage radiation and it gave me another 2 1/2 years before it came back again, and I had to go on Lupron.

Unfortunately, you have waited too long to get treatment. I suspect you are not under the Direct support of a doctor that specializes in prostate cancer, Or you would’ve had something done much sooner because your doctor would’ve demanded it.

If you didn’t get your salvage radiation treatment at .2 you may end up regretting it because of a much shorter overall survival. As you can see from this listing, you have waited past the amount of time they recommend, And in this case, ADT is really mandatory if you want to try to prevent another reoccurrence.

You really need to get involved with a good treatment team. At this point in your treatment, you should see a doctor at a center of excellence or a Genito urinary oncologist, The ones they specialize in prostate cancer.

Here is a listing which shows what should be done when Prostate cancer surgery fails and your PSA starts going up

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.

I am so sorry that you have to deal with recurrence so soon. : (( Unfortunately it happens sometimes.

The good thing is that there are many additional treatments that can be implemented and will successfully stop cancer growth. Just make sure to go (if you can) to a big and good medical center with excellent ratings. Also, you can use this forum to get support and a lot of advice from PC veterans here. In the meantime don't forget that you also have an option to go through older posts by using the "search" option.

Would you mind sharing your initial Gleason score and biopsy and pathology findings ?

Well, similar...

Difference is my BCR was 18 months not three years and we did SRT at .2.

The SRT was an epic failure in part because I let my medical team dissuade me from including the PLNs and doing short term ADT, six months.

So, the clinical data you describe may indicate advanced PCa.

You say PET scan, wait a PSMA? If so, surprised as with the PSADT and PSAV, a PSMA s an has a statistically significant chance of locating activity and informing a treatment decision. If it was a conventional PET scan, well, either your medical team is behind or your insurance company likes paying for it first then paying a second time for the right scan.

All that aside, like in busines, those are "sunk" costs and not Germaine to the decision ahead.

First, if you have not had a PSMA PET scan then cajole your medical team into ordering it. Knowing where the activity is may be useful in a treatment decision.

You do have choices, discuss with your medical team.

There is some data that says it may be 8+ years before significant "activity" forces a treatment decision. Were it me, with that kind of kinetics, I would not choose this.

You could do radiation combined with systemic therapy. The radiation could treat the prostate bed and whole pelvic lymph nodes. The systemic therapy may be ADT + ARI for a defined period. How long...in part depends on your clinical data, GS, GG, PSADT and PSAV plus other data such as decipher score if you had that done. That will determine which risk category you are in and guide the duration - 6, 12, 28, 24, 36 months... as to which ADT and which ARI, again, discuss with your medical team (and insurance company...) there are distinct different though the side effects of no testosterone are generally common to all.

For some, chemotherapy is in play as part of triplet therapy. My take on that is may be of better use in high versus low volume cases.

What I would not do is SRT to the prostate bed only and blindly!

So, if not already, discuss with your medical team getting the PSMA imaging done.

Read up on the guidelines such as NCCN and AUA.

Discuss with your medical team the array of choices and decide.

As always, when you have those discussions, share with the forum for our thoughts and experiences, "been there, done that...!"

I've said this before, the advances brought about by medical research have changed the treatment landscape and brought a dizzying array of choices both in the guidelines and emerging from clinical trials. The downside, like Alice in Wonderland we can spend a lot of time going down that rabbit hole.

I am in the camp that there are good choices, there is no single "right" choice when making treatment decisions

I've given you an example of what may be a wrong choice, my SRT.

An example of a good choice.

In April 2023 I wanted to do SBRT plus six months ADT when a PSMA scan showed a solitary lymph node. My radiologist supported that. My oncologist wanted to do SBRT, add 24 months ADT+ARI based on the guidelines, the EMBARK trial and the guidelines. We settled on SBRT + 12 months ADT, hold the ARI and revisit our decision at 12 months, decide whether to cone off treatment or continue in three month increments, decide...

We came off at 12 months. Here we are 15 months later, all quiet. So, who was right, who was wrong? Nobody, we made a good decision, that's all.

Kevin