Good News on PET-Scan, time to consider next steps

If the PSMA PET scan didn’t show anything, how will they know where to target the radiation? (With a 0.10 PSA, PSMA PET scans will miss prostate cancers 70%+ of the time.)

Did your PSMA PET scan result in any reported SUVmax scores?

“limited sensitivity in assessing the prostatectomy bed because of early urinary excretion of radiopharmaceutical” makes sense because the radiotracer being excreted hides anything else nearby that might show up under the scan.

Dr. Kwon (of Mayo Clinic) indicates that only 1/3 of men who have recurrence following prostatectomy have recurrence only in the prostate bed, and that they should not get salvage radiation there unless they’re absolutely certain of the location of recurrence. He says to first confirm where the recurrence is. (See Dr. Kwon’s presentation about recurrence: https://youtu.be/Q2joD360_pI)

Usually, they wait till your PSA gets to .2 before they do salvage radiation. That’s what they did for me. 12 years ago I had 7+ weeks of salvage radiation and had no side effects of any sort. Five years later, I started to have some incontinence issues, But after the radiation, I had no problems. I would have it done early in the morning and would immediately go to work after and work a full day in my computer consulting business.

If they were to have found something with the PET scan, they would’ve used SBRT radiation To zap it before doing salvage radiation. A couple of years ago, I had to have a metastasis zapped on my spine, After doing that, I’ve been undetectable for two years.

They did not discover anything due to your ultra sensitive PSA, that just showed that there was something somewhere, And it’s frequently mini metastasis in the prostate bed.. The usual technique is to radiate the prostate bed, That gave me 2 1/2 years without any further reoccurrences in my case, But I have a genetic problem that caused it to come back.

You don’t discuss what they found in your prostate after they removed it. That can be critical information. Did they find extra capillary extensions, intraductal, Cribriform or seminal vesicle invasion.

Here are the ASCO guidelines for when to Do salvage radiation

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/
I can’t imagine what a naturopath doctor could possibly do for you. A couple of years ago, the FDA said holistic medicine is worthless. It has absolutely no medical value. So you can spend money on it but it’s not going to make any difference since they use infinitesimal portions of items that might have some value.

@brianjarvis
Salvage radiation radiates the prostate bed where it’s most likely that something is growing as a result of the prostate being removed, and as Drs Kwon and Moyad have said at PCRI “Seeds for metastasis were already there when surgery was done, waiting to grow.”

I am doing a lot of research about salvage and adjuvant RT post RP and as far as I read (and I read a ton of papers) when PSA starts to rise the earlier you do a "clean up" , the better are long term results.

When PSA starts rising it can rise rapidly and if you need to wait for marker placement and getting in line for the procedure it can take month or two in a very busy center which will possibly push your PSA above 0.2 and that is not desirable by any means. PSMA scan will not find much (if anything) at 0.2 either, as far as I read.

Since your PSA is rising it is good chance that it will continue to rise and you will have to do RT anyways. BUT, if you are not yet ready, you have some time so maybe you can do PSA every month to make sure there are no surprises and in the meantime organize all that will be needed for RT and make sure that all is in line and ready to start RT on short notice if PSA starts doubling fast.

Yes, RT can have side effects : ((, but what choice we have ...

@jeffmarc Yes, those “metasti-seeds” (as Kwon sometimes refers to them) can be anywhere in the body.

But, Kwon cautions in that presentation that “…only 1/3 of men who have recurrence following prostatectomy have recurrence only in the prostate bed, and that they should not get salvage radiation there unless they’re absolutely certain of the location of recurrence.” He says to “first confirm where the recurrence is.”

Thank you for the responses.
2023 Pathology: Tumor: Type: Acinar adenocarcinoma. Grade: Grade Group 4 (GS 4+4=8)
Intraductal Carcinoma (IDC): Present. IDC Incorporated into Grade: Yes.
Cribriform Glands: Present.
Greatest Dimension of Dominant Nodule: 17mm.
Seminal Vesicle Invasion: Present, right.
Lymph vascular Invasion: not identified.
Margins: All margins negative for invasive carcinoma.
All regional lymph nodes (7 examined) negative for tumor.
Pathologic Stage Class: (pTNM, AJCC 8th Edition); Primary Tumor (pT): pT3b; pN Category: pN0
Prostate specimen...Left seminal vesicle was measured, the right is absent and may have been transected at the base of the prostate. [Interesting]

September 2025 PET-Scan Notes:
Parotid/salivary SUV max 14.6
Liver SUV max 7.3
Mediastinum SUV max 2.0

Extraration of activity in the left (arm) antecubital fossa injection site migration through the lymphatic system to multiple left axillary lymph nodes, i.e. lymphoscintigraphy phenomenon. [I mentioned this to my PA: After tracer was released, the nurse added saline to the IV with pressure, my left arm started to bulge up. She pushed it down. My left arm is bruised after the PET-Scan IV]

Left renal cyst. Small fat-containing umbilical hernia. Redundant sigmoid extending into the right lower quadrant. Degenerative change in skeleton. [?]

I will meet with Radiation Oncology ASAP to get my SRT process started,

@stjosephstmary

That sound good. Just make a plan with your doctor and ask about the scheduling 👍.

Maybe his practice is not too busy and things can be arranged fast, if needed. My husband has to wait for months for any app.

You have some time, so take it and just start organizing everything and that way you are ready for RT when it becomes needed. You might even look for a second opinion if that will ease your mind. 👍

Regarding other findings (cyst, small hernia, osteoarthritis ) they are very, very common, do not worry about them ; ).

@stjosephstmary
You have multiple very aggressive things going on with your prostate cancer. All three of the following things mean that your cancer is much more aggressive than your Gleason score shows.

Intraductal Carcinoma (IDC): Present. IDC Incorporated into Grade: Yes.
Cribriform Glands: Present.
Seminal Vesicle Invasion: Present, right.

If you just had one of these three things, it would not be good but you have all three and getting salvage radiation as soon as possible makes a lot of sense.

You should do some searching about these three items, you will find that they are very aggressive. They actually have said a UCF seminar that if you have cribriform and intraductal That really puts a five in your Gleason score.

You should ask if the cribriform Is small or large. Large cribriform Is much more aggressive.

I’m not surprised they want to do salvage radiation as soon as possible, Your chance of reoccurrence is very high. With all three of these things, a decipher scores is probably not even worth doing, It would tell you your chance of reoccurrence, but you have so many aggressive things going on that the chance of reoccurrence is very high.

Be proactive about your treatment, Your progression free survival is dependent on getting the right treatment as soon as possible and staying on good treatment.

According to most medical advisors with all these negative things you have you should be on ADT plus an ARSI (Zytiga or a lutamide). Speak to an oncologist about this, Preferably not a medical oncologist you need to speak to a Genito urinary oncologist, They are the ones that specialize in prostate cancer. If you could mention where you live in the country, we could give you information on oncologist to speak to.

Be aware that if you have reoccurrence before three years, you are much more likely to have future reoccurrences. I’ve had four but I’m still alive after 15 years because I’ve stayed on the correct drug treatments for my situation.