Anyone had salvage radiation therapy post-prostatectomy?

I had Salvage radiation at 66. I had it in the morning and went to work right after, every day. I never had a problem during the y week radiation treatments, but some people do. Most common are fatigue and urinary problems but it seems but most people have minimal side effects.

I had 39 treatments 7 years after my prostatectomy. My PSA , the. went down to 0.01 for 2 years. Unfortunately my PSA is back on the rise again. I will be having a PSMA scan done in the future .

I had salvage radiation about a year after surgery, and then again a couple years later with spot radiation around my abdomen area after a lymph node lit up in a PET scan. I had no material side effects from the prostate bed radiation, but when they radiated around my stomach, I did have fatigue and a bit of nausea at times.

I wish I had gone to a center of excellence, like Mayo, the first time, as they would’ve done a PET scan to assess where exactly the problem was.

@mmmvegas There is radiation... and then there is radiation. Many different types that cause more...or less side effects. Here is a link to a Urology Times article talking about the difference in side effects and toxicity between a built in mri radiation machine vs radiation machines that use fused images. The differences are significant.
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

My 1st 90 day postop PSA was .19 and led directly to Salvage Radiation Treatment. All at Johns Hopkins.
Postop path G 9 w/ EPE.
Recurrence is roughly defined as PSA of .2. Sweet spot for treatment has been .2 - .4/.5
However it appears trend is to treat sooner.
A friend 5 yrs postop with PSA < .2 just initiated Radiation at a MD Anderson facility in NJ w/o ADT.
I had a short term course of 4 mos Orgovyx (see SPPORT trial).
Whether to add ADT hormone therapy is an important Q.
If a PSMA pet scan "rules out" distant metastases, then the belief is that the cancer cells are in the prostate floor and pelvic lymph nodes and those areas can be radiated.
Issue is the PSMA scan is only about 20 - 30 % accurate at PSA level of .2
Personally, I would want to initiate Radiation sooner than later. And I had 37 IMRT txs to the whole pelvic region together with the pelvic lymph nodes. The longer tx time with lower Radiation caused some mid treatment bowel discomfort and diarrhea, which disappeared 2 - 3 wks after treatment.
There also seems to be a trend of ROs/MOs ordering shorter courses of ADT or none. Certainly I do not know what is right for you. However I think that my ADT SEs were more prominent than my radiation side effects.
6 mos after completion of treatment with both however, my PSA was < .02 and I had recovered 90% from the SEs and traveled to France for 2 weeks.
Best wishes on your decisions.

Short answer, I had SRT in March 2016 after BCR.

Standard treatment at the time, 39 IMRT, weekends off, 70.3 Gya.

The biggest hassle, bladder management since they wanted it to be "full," thus lifting it out of the way of the path of radiation to the prostate bed. Tere were a few treatments where I wasn't sure if I was going to make it through without having to let some out first.

The 2nd biggest hassle, figuring out what schedule worked best for you, morning, late afternoon. I was still working so my preference was to do late afternoon.

Today's planning software and delivery systems are pretty sophisticated.

I experienced no side effects during treatment, nor after,
'
That's me though!

Kevin

Yes I would agree with your radiologist. .13 is not considered BCR.
My opinion only is to continue to monitor your psa (every 6 months) and track your psa velocity. the sweet spot for SBRT is when your psa is between .2 to .5. The side affects in most case are minimal .

All the comments from the forum are solid gold and there are tens of thousands of men who’ve been in a similar situation - myself also.
I chose radiation and 6 mos ADT 6 yrs after surgery; I read all the literature, all the trials, all the 10 and 15 yr comparisons and outcomes and it all came down to one simple question:
What was I MORE afraid of - the radiation or the cancer?
That’s the only thing that matters when all is said and done.
You’re 68 -relatively young - and you could easily live another 20+ years. It’s taken your cancer 14 years to clinically recur, so how aggressive can it really be, right? However, you need to also consider your PSA Velocity. If it’s taken sudden jumps over the past year it could indicate a rapidly growing tumor or cluster of cells.
As @michaelcharles pointed out, PSMA scan at these low levels are not great; in fact, a few days ago a poster had a PSA of 10.0 and nothing showed!
You can certainly monitor your situation with 3 month PSA tests - any trend upward with increased velocity should make your decision easier. I’m no expert but 3 PSA’s over 9 months should not appreciably change your course if treatment should you go down that path. Best,
Phil

I had salvage radiation about a year after my RP. PSA never got to undetectable after the RP and my doubling time was less than 1 year. I had a small positive margin. I went on Orgovyx for 6 months and in the middle of that treatment I had 39 IMRT treatments. My PSA at the start of the ADT/radiation was .17. In the research I did, I found that the lower your PSA when you start SRT the better chances for a cure/ best outcome. I am now about 9 months after the radiation and my uPSA is undetectable. Radiation did cause some degradation of continence and ED, but I am making progress on both. Good luck on your journey.

Diagnosed with PC in 2014 53 years old. Chose RP after several discussions with drs at Mayo. Check ups on 6 month intervals. 2020 PSA numbers started showing after being undetectable. .14, .32,.39 the 39 daily treatments radiation to get that stopped. Was on a testosterone therapy drug for 3 months thru this…. Terrible.
Numbers were once again undetectable… until cancer numbers started to slowly rise again 3 yrs later. Then all hell broke loose. Bladderneck bleed n clotting, ER rooms and a surgery to cauterize the area. On and off catheters and incontinance in between.
Tried 68 HBOT prior to another surgery in October ‘24 to try to repair the bladder neck/ fistula with an Omental flap procedure Not successful. Terrible 3- 4 months following with catheter in place. Decided cystectomy was last chance. Waited 3 months for appointment Finally relief of badder/ urethra pain. Now learning to deal with infection in pelvic bone with 4 antibiotics and being a member of the urostomy family, and a slowly rising PSA ….again.