For men who had SRT - what was PSA on day of 1st session?

Don’t sweat the radiation being too late, you are a little late, but not significantly.

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.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/
The SRT will probably bring your PSA back to undetectable. Are you already on ADT or an ARSI? With a Gleason nine and having a reoccurrence, you normally want to have both of those drugs. If you have a choice, tell the doctor you want Orgovyx A pill you take once a day for ADT.. Once you stop, your testosterone comes back quicker than with the other drugs. They will probably put you on Abiraterone (Zytiga). If they want to put you on the lutamide Instead, you should tell them you want Darolutamide, It has the least side effects and doesn’t pass the blood brain barrier. You have to be proactive and say what you want, Let the doctors know you understand the differences and that is your choice.

I had eight weeks of SRT and had no side effects at all at the time. I had it first thing in the morning and went to work right after worked a full day without any problems. If you’re having less time doing it, then they give you more radiation and the side effects can be more problematic. Usually, you have urinary issues and fatigue when you’re getting a lot of radiation. If you have problems, let them know right away, They can always change the dosage.

@kenshabby
I am not a medical professional so my question may seem strange. Did you have RP? And your post is a recurrence of PSA?

I did not have RP and want to limit my posts to what I have expereince on. If you did not have RP then your PSA is very low so would be confusing for me unless you did have RP which is totally out of my experience to post on.

Hey Ken, I see no mention of ADT in your post. With a recurrence of a Gleason 9, surely you were placed on ADT immediately?
G9 is an aggressive cancer and you should have been given it right away once recurrence was confirmed.
So any delay wouldn’t have mattered since the ADT would have kept the PSA from going higher. I would SERIOUSLY have a sit down with your RO right now.
Phil

@jeffmarci I am on Lupron. Just had a 4 month shot 2 days ago. This follows a loading dose of degarelix on 10/13

I’ve been on daralutimide since October 13. Onco wanted me to hold off until PSMA PET was done.

I received a PSA reading of 28 in mid April 2022. Didn’t get any sort of treatment until late July. The industry talks frequently about how slow moving the cancer is but the falloff in RT efficacy when PSA goes > 0.20 suggests that delays in treatment kill

I don’t understand why my urologist didn’t shoot me full of degarelix tge day my PSA of 28 was known. I don’t understand why current onco didn’t do the same in July of this year

I’ve trusted doctors implicitly especially bc I’m being treated at a world famous cancer hospital with big Ivy League brains & egos all over the place

@heavyphil Depends on what the definition of confirmed is

My PSA in concert with my testosterone (comfortably within castrate limits confirmed recurrence in July - if you ask me

My doctor waited for a PSMA PET scan on October 3 to confirm & I didn’t receive degarelix until 10/13/25.

@jc76 I had an RP in December 2024. Was on degarelix before and after so low PSA was illusory

Went off Degarelix in June 2025 though rising PSA hinted at recurrence & castrate resistance.

Cancer game roaring back. Or, more likely, cancer the surgeon missed became evident when we ceased degarelix

@kenshabby
Really strange they want you to hold off on Darolutamide, Which doesn’t reduce your testosterone so it doesn’t have any effect on the PSMA pet test.

The thing is, Getting the degarelix Shot stopped your cancer from growing and spreading. The Lupron shot does the same thing but reduces your testosterone even more only because you got it second. Some people get one degarelix Shot after another and it also keeps your testosterone way down.

Between the two drugs, your cancer has actually been stopped, Your PSA probably came down significantly as well. That makes it so that your radiation can be delayed a little without any negative effects.

Over at ancan.org Weekly advanced prostate cancer meetings, one of the doctors that attends almost every meeting talked about the fact that his urologist put off his rising PSA for a long time, resulting in him having a much more aggressive prostate cancer. I’ve heard the same thing from many other people. Some Doctors!!!! That sounds like your doctor that didn’t give you anything for 3 months in 2022. People have to be proactive, but they don’t know they need to do that when they are first diagnosed.

@kenshabby
So sorry kenshabby to read this.

I did not have RP but I know those that did most wanted to get rid of the PC with the hope all at once. It really saddens me to read posts like this.

I did not have RP nor hormone treatment so can't give you my personal experience with this but I wanted to respond with my total empathy on dealing with this.

I hope you are getting the proper care now.

@jeffmarc
This statement I made was wrong

“ Really strange they want you to hold off on Darolutamide, Which doesn’t reduce your testosterone so it doesn’t have any effect on the PSMA pet test.”

Darolutamide would reduce your PSA and thus make the PSMA pet test less reliable. Not sure why I didn’t get it right the first time.

@jeffmarc thank you for the diligent follow up

I think I now understand my doctors insistence on having a scan before making a call. My primary complaint with respect to this recurrence is that we waited a bit too long with respect to how high the PSA.

There’s a school of thought that says letting it run a little bit makes for a better scan, and it’s more art than science in choosing when to restart ADT. However, I do think there is generally a lack of urgency in things like scheduling scans and the RT.
I’m being treated in New York City and sometimes I forget that there are other guys out there who may need a scan. And gals too.