Post RT 6 years after RP with Rising PSA now at .28.

@heavyphil Yes. According to my research it is possible for healthy cells to survive. And surviving healthy cells do regenerate. My urologist concurs.

@zhit Thanks, Carl - often wondered but never pursued the idea since my head is already at the point of exploding with way too much info to process….when even an AI model says ‘sorry, I cannot help you’ you know you’ve fallen down the rabbit hole of possibilities😳
One last thought: Did you have ADT with SRT? I mentioned it in my post but don’t think you did.
I opted for it even though the new protocols say that you don’t need it for PSA’s lower than 0.7. I wasn’t going to kick myself in the ass a few years after SRT for not taking that extra step, useful or not.
Phil

@heavyphil No ADT yet nor was it suggested until we had more info. I consider myself lucky and try not to focus on the past. I'm 78 and still have good quality of life.
Hope your #s stay low. 😋

@heavyphil

We were advised that if we ever need (or want) salvage (or adjuvant) that 6 mos ADT is preferable. It seems that again every institution has it's own protocol. However as far as I read research papers show that having ADT gives better results as well as treating pelvic region + nodes. BUT, protocol is probably also adjusted to individuals age and health status in general. All studies usually have "average age of 65" and usually exclude patients over 70 not because they have different response but because they wish to follow patients for 15 years. At least that is my understanding.
It should not be surprising that healthy cells survive - if radiation caused all cells to die that would be devastating - than surrounding healthy tissues would die too , god forbid. This is how radiation works - it kills abnormal cells if it is done correctly (correct strength and correct amount). ADT theoretically makes abnormal cells even weaker.

Also, lets not forget that salivary glands can produce PSA as well as pancreas and breast tissue and that viral infection can increase PSA temporarily even after RP. That is why IMHO it is important to follow a trend of PSA rising and not concentrate on a single occasional blip on a radar.

The GU I saw at a CCCenter said wait for PSA to get to 2 and then they can find the spot and treat it. This led to some interesting discussion on the thread. The cancer needs to be large enough for PSMA PET to see. I am undecided as to what I would do if I bounce again. Probably start with a GU at another facility. Currently 2 months post ADT with Orgovyx and 7 months post 25 sessions of radiation with my T @208. At my appointment it was stated that my T is high enough to trigger a psa response. My normal is 250. Back for testing in January.

@chippydoo
If you have radiation as your primary treatment, the normal point at which they proceed is when your PSA hits 2 points above the minimum it ever hit.

If your PSA is actually rising while you’re on ADT, then you could become castrate resistant. That is highly unlikely as short of time as you’ve been on ADT.

If it’s not rising, then it’s a matter of how long it takes to hit the bottom Before you wait for that two point rise. You don’t mention what your PSA is and what it has been the last few times you’ve had it tested, Since it’s been seven months, have you had it tested twice? Has it gone down each time Its been tested?

Tested once at two months post ADT/salvage treatment, micro whatever undetectable is .014(?) with my T at 208. My PSA never went undetectable (micro) post RP. Lowest was .03 followed by .04 then at 18 months .08 at 24 months .22 At 27 months .24 and started ADT 3 weeks prior to 25 sessions EBRT salvage. I will test again at 6 months. I am not declaring victory with this insidious form of cancer and have my expectations in check. I am not going to over test every 30 days and will do my best to live my fullest life until testing dictates other actions.

@surftohealth88 The part that always bugs me is the notion of ‘healthy prostate tissue’…why have an -ECTOMY if you ‘re gonna leave pieces inside that may become cancerous down the road??
Sure, ‘nerve sparing’ is the term used to imply that nerve bundles will be left intact and that protocol does necessarily leave tissue behind…it has to.
We all agree that PNI is not a gauge of aggressiveness but it is still a metric used to show the lateral spread of PCa cells…do we really want to do nerve sparing in these cases? Peri-Neural Invasion is just what it sounds like, right? Invasion of the area surrounding the nerve bundle to a greater or lesser degree.
I don’t believe a surgeon - even using the DaVinci robot and frozen sections - can painstakingly dissect away every last bit of malignant tissue and leave the nerves intact and unaffected in most cases. One cell left behind is all it takes for recurrence.
This is why I told my surgeon to spare nothing questionable, even at the expense of my virility; I wasn’t having surgery for the fun of it.
But ADT combined with radiation probably does kill/damage a certain amount of healthy cells even if that is not the goal. ADT is going to weaken healthy prostate cells as well, since they too rely on T. They will not replicate as fast. Weakening them, in turn, makes them more susceptible to having their DNA damaged by ionizing radiation.
Isn’t damage from radiation a HUGE factor in the initiation of cancer? So back to my rabbit hole conundrum: if ‘healthy’ prostate (not bladder, bowel, etc) cells are weakened by ADT and then blasted with radiation, can’t these cells become malignant and cause recurrence especially if they don’t die?
How would IMRT or SBRT ever be as statistically successful as it is if ONLY PCa cells died?? How can the beam know who is friend or foe?? Those ‘margins’ that we speak of are killing fields designed to eradicate anything in that area, so some healthy cells are killed as well just to be sure…
Other types of body cells are spared (mostly!) by the beam shaping capability afforded by the computer assist in the machines. But some secondary cancers DO occur down the line no matter how accurate or what type of particle is used.
Phil

@heavyphil

EXACTLY ! All that you said is true.
Not only that, even if healthy cells survive and are healthy at the time, they can become cancerous even without radiation - that is what happened in the first place - healthy gland over time collected mutations and became cancerous. That is why I do not completely buy theory about "dormant seeds" in cases when BCR appears 15 years later out of the blue.
Also, one of the reasons we chose RP was that I read a study that showed that IF cancerous prostate tissue survives radiation there is even worse case scenario left - cells with abundance of new mutations , IDC galore, cribriform on power of 10 , etc. 😵‍💫

It is better to be ignorant, but I just can not stop reading and discovering stuff, I am biologist after all lol 🤷‍♀️. I wish I do not know 90% of things that I know now . I thought knowledge will give me some power and answers, instead there are no clear answers and there are "too many facts that keep me awake". No matter what : " what will be will be" 🤷‍♀️😵‍💫, no matter what we do or not do.

Hey - we are in "non detectable" zone TODAY - so : "Lets gooooo flyyy the kite, up to the hiiiiighest height" 🎶🎵🎶 👯‍♀️👍 .... Foliage must be beautiful on the East coast this time of the year 🍂🍁🍂🌿🦔 !!! : )))