one year post radiation advice

I’m confused…. Is this indicating that you’re 1 year post-radiation treatment of your prostate and the PSMA PET scan is still picking up a cancer in your prostate (of SUVmax 3.4)? Or am I misreading this?

In this PET scan report, what is the SUVmax of your blood, liver, and parotid gland?

Hey gently, why did they do a scan in the first place? Routine or rising PSA?
If it’s the latter, maybe you have to have more frequent PSA tests to see if there is an increased PSA velocity. Don’t remember your primary treatment - was radiation primary or salvage?
Phil

10 years after RARP and 39 Salvage Radiation treatments I had rising PSA. So far PET found cancer in the left iliac (zapped with Photon Beam), PSA still rising PET found cancer on right iliac (zapped with Photon Beam), just has PSA test - still rising going for yet another PET. Last PET showed bone metastasis in L3 area, but MRI did not pick that up sooooo....

Many different experiences you'll hear here, but never stop, even if you are destined to never be "cured".

What is your PSA?

That is what determines whether or not there is a need to do something right away.

Your doctor has to determine whether or not further radiation could be done in the same area that there are issues. You can’t radiate the same area twice in most cases.

Some doctors will do surgery to remove tissue that was radiated. That may be your choice, but it depends on things like your PSA And how available the spots are for surgery.

@heavyphil
Phil, thank you. Radiation was primary. The second PSMA was scheduled at the time of treatment. There was an equivocal node that orgovyx hadn't affected which made the determination that it was not metastatic. PSA reached the lowest .27 six months post radiation, now .28.
I wondered how unusual it was to have an after PSMA. The doctor said that she usually orders one at the one year mark.
I'm wondering how to handle the sub centimeter right iliac node close to the nerve bundle.
Do you know about microscopy? Would PSE be useful?
I appreciate your attention.

@jeffmarc
Jeff, PSA is .28 up from ,27 six month age. SUV in the prostate isn't concerning? If you take out the node does that prevent metastasis or if it is in the node does that mean that it has already escaped the prostate and is in the bloodstream. Is sooner better?
Thank you.

@brianjarvis yes, the SUV max is 3.4 and the outline of the tumor remains.
I only have the addended report from mychart, so I don't know blood, liver or parotid numbers
Radiation was the 5 fraction 20 GY total of 40. Do you think they can re-radiate to a higher total GY of the usual 80GY.
Maybe a person has to wait to see if it really is cancer.
I appreciate your response and will return when I have the other SUV numbers.

@briang1958 brian, were the cancers found in the nodes. How intense was the photon. So will you treat L3. Does its invisibility on the bone mean that there no damage to the bone, yet. You are conducting a good fight. Thankyou for the encouragement.

@gently This is a situation where if it were me, I’d have a very detailed discussion with my RO as to what’s going on.
> what was your PSA and Gleason going into SBRT?
> did you use hormone therapy?
> did you use a rectal spacer?
> do you have the full PSMA PET scan report from prior to the SBRT (to see the SUVmax scores for your blood, liver, and parotid glands at that time)?

(That probably should be “5 fraction 8 GY total of 40” right?)

They won’t likely re-radiate unless they don’t believe that 40 Grays was enough biologic effective dose. (It should’ve been; depends on what your initial diagnosis was.)

Dr. Rossi talked about re-radiation at the 2023 PCRI Mid-Year Conference at: https://www.youtube.com/live/WTqPnSRYtW4
—> Starting at about timestamp 4:53:00

Dr. Rossi is talking about proton radiation, but the same concepts probably apply to SBRT and IMRT as well. As he mentions, there are other options that are preferable to re-radiation.

As for waiting “to see if it really is cancer…,” your numbers (e.g., PSA, Gleason, SUVmax) are what would indicate that.

What is your doctor’s opinion on what’s going on, how this could’ve happened(!), and plans going forward?

@gently

Yes, the "Foci" were on the left and right iliac nodes. If truly important I can get the information regarding photon strength.
Mayo doctor said the PET could have been in error (or reading of it), but it was not seen on MRI so no radiation on spine.
Next steps TBD.
To be totally transparent, I had Lupron during my radiation treatments 55 years old high T and it really really clobbered me to the point I did not want to get out of bed. I have not been on ADT since then and had a good 10 year run without it with undetectable PSA. I am pretty sure some sort of ADT will be part of my treatment going forward, but then again, I have learned not to anticipate this thing that has invaded my body.