Did you start radiation immediately or wait until PSA was 0.2 ng/ml

Here are the guidelines from a doctor investigating best treatment
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html
Dr. Efstathiou concluded as follows:
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur.

Thanks Jeff for re-posting my link, I really hope some doctors will read those findings too and start acting accordingly *sigh

Great information - very well laid out. Thanks so much.

I didn’t write down who originally posted this article. I’ll reference you in the future.

Really some great information.

Oh no need Jeff, please don't even fret 🙏 - I am just happy that you are posting it again since you have much , much more visibility and I pray doctors would read this , or at least that some patients will have a doctor who would give them opinion about this and that they will share it here because I can not hope for getting opinion otherwise.

THANKS Jeff for all the hard work and support that you are doing for all of us here 💗.

PS: English is my second language so often the true meaning is "lost in translation" and I can now see how it sounded *ugh , what I meant was "thanks for re-posting the link that I posted couple of days back and that is very important for potentially solving mine problem".

I was in the 2 hour ancan.org Advanced prostate cancer online meeting today. They were discussing Dr. Eleni Efstathiou who wrote that article? She is a really well known and a really great GU oncologist. They didn’t discuss the article you posted, they just talked about so many things she had done for people.. One of the guys in the meeting has her picture up behind him so you can see it while he is there (She’s pretty attractive). There are a few people in the Ancan meetings who live in and near Houston and go to her for treatment. She is great to talk with, and extremely helpful from what they say.

I did post the link to the article you initially posted, in the chat, during the meeting, so others could see it as well.

All I can say is that you have positive margins; you STILL have documented prostate cancer inside you, regardless of the surgery. What good was it if your surgeon couldn’t get it all?
OK, so you had a gross debulking of the tumor nidus, and a clear picture of what’s going on based on your surgical pathology report…excellent.
Your surgeon is completely useless to you now as a source of treatment. Time to consult an RO to treat the cancer still inside you before it gets worse.
If you are comfortable with waiting for the magical 0.2 PSA - mostly used in cases where the surgeon knows he ‘got it all’ - go ahead. Me? I’d be running…
Phil

This is exactly my issue. Gleason 9, bladder neck, multifocal, cribriform, LVI. So the cancer remains. Surgery was November 2024. Second PSA test was low but detectable - 0.02. Urologist is waiting for at least the next PSA on Oct. 1. I don't understand why we're waiting for radiation. I have a contact with an RO and I'm trying to schedule a consultation to get his opinion on what I should be doing. So frustrating.

Normally, they do salvage radiation at .2. At .02 it would make sense to wait for the next couple of PSA test to see if your PSA is actually rising.

The prostate cancer guideline Say that if you’re < .1 Then you are considered undetectable. They do not consider the ultra sensitive PSA tests in that decision. So you are undetectable therefore at this point, no treatment is essential, yet.

Your PSA could bounce around a little, That’s why your doctor wants to wait. I would ask for monthly tests, not wait till October.

Thank you. I think urologists have a "wait and see" mentality because prostate cancer grows slowly: "Nothing will change much in three months." But..."growth is growth", "spread is spread", so why do they wait? They push the RP surgery on you right away, but then knowing they didn't get it all and that there are surgical margins and the rest of your pathology that has now likely shortened your longevity (EPE, Cribriform glands, seminal vesicle invasion, maybe bladder neck spread), it is suddenly: "let's wait three months to see what your next PSA is, and then we can 'talk about' radiation." Meanwhile, you read accounts here on this Mayo blog, of patients being taken to radiation therapy immediately after surgery whether they had the ominous pathology features or not, and well before they even have their first 3-month post-op PSA.
This "industry" needs better standards of care. Every clinical discipline that spans the entirety of our health and lack thereof, has what are called "Standards of Care." Physicians, Nursing staff, Quality Assurance, and others, get together at conventions and seminars, then back to their own facilities to establish how they will diagnose, treat, and cure everything that is within the sphere of a certain disease. There are currently Standards of Care for Prostate Cancer, but it seems they vary significantly from physician to physician and region to region across the country. The more I read this blog the more I am convinced of it, and confused by it.