Salvage radiation therapy after radical prostatectomy

I had a Prostatectomy in 2006 then had 39 radiation treatments in 2013 for recurrent cancer. I now have urinary frequency, bowel movement frequency and ED. I’m now on my 2 nd recurrence and both of my doctors are just watching and waiting on my PSA levels.

Well, as others have said, those who have not experienced side effects from SRT, may not post on this or other forums.

I did SRT after a very successful surgery in March 2014, PSA was undetectable using standard PSA to a single decimal point until 15 months out (roughly September 2015) when it came back as .2, then 90 days later, was .3.

At the time, data was emerging from clinical trials as well as Mayo that in high risk PCA with BCR, there was often spread outside of the prostate bed to the PLNs and recommended treatment was SRT to the prostate bed, extend to the WPLN and include short term (six months) ADT.

I brought this data to my medical team who dismissed it saying there was no long term data to support it and the SOC was SRT to the prostate bed only.

Ninety days after completing the 39 IMRT, 70.2 GYa to the prostate bed only, epic failure.

So, understand your decision as it is from your radiologist, it is the "SOC" though as I have said before on this forum, are population based and historical, question, do you have an oncologist on your medical team, if so, what did that individual say, if not, consider consulting one.

The NCCN Guidelines, #13 for PSA persistence or recurrence after surgery suggest that if no other signs of cancer, radiation with or without hormone therapy or monitoring (see, choices, no definitive answer...!). So, your PSMA tests says "no cancer sign of cancer...yet, we intuitively know there is, otherwise your PSA would not be rising. At that PSA, low probability, rough 1/3, of finding any recurrence. There may be other data to aid in your decision making, the pathology report from your surgery which would indicate GS, GG, PSA tests which would give your PSADT and PSAV...

Question is, how aggressive do you want to be? In part, that depends on how aggressive your PCa is. The fact that it has returned may answer that question. As I said, so will your pathology report and PSA tests over time.

But, to answer your question since I haven't yet. I did not experience any SEs from my SRT. Why, who knows. I'm going to go with a highly skilled radiologist and her team.

Kevin

The short answer...the fatigue is likely the Orgovx and Zytiga, the nausea more likely the radiation.

Zytiga definitely causes fatigue even if taken with prednisone. My husband has taken it since January 2020 and the fatigue doesn't decrease with time. The nausea is probably the radiation as it is likely close enough to the stomach to cause it. See if your doctor will prescribe oral Zofran, anti-nausea dissolving tablets. Those helped when taken just before radiation and also after nausea starts.

Quick question: I’m currently going through 33 sessions of salvage radiation to the lymph node basin for Gleason 9 with EPE If that sounds familiar. Three weeks down and I’m experiencing substantial fatigue and mild to moderate nausea. I’ve also been on Orgovyx and Zytiga for three months. Did you experience any of this?

I am being treated at the Dan L Duncan Comprehensive Cancer Center in Houston. It is on the NCI list, but is it a Center of Excellence?

Quick question: I’m currently going through 33 sessions of salvage radiation to the lymph node basin for Gleason 9 with EPE If that sounds familiar. Three weeks down and I’m experiencing substantial fatigue and mild to moderate nausea. I’ve also been on Orgovyx and Zytiga for three months. Did you experience any of this?

What an awesome question! The National Cancer Institute recognizes centers around the country that meet rigorous standards for transdisciplinary, state-of-the-art research focused on developing new and better approaches to preventing, diagnosing, and treating cancer. Arguably there likely are several centers of excellence in the United States that don’t meet NCI criteria because they’re not doing research qualifying research, but nonetheless have the most state of the art equipment, qualified staff and interdisciplinary treatment. When I started my journey with PCA, I had zero appreciation for the difference between just any health system and a center of excellence. I was under diagnosed and under-treated and now being treated for Gleason 9 PCa and my life has changed forever. I hope that doesn’t happen to you.

Here is a link to all the NCI approved cancer centers in the US sorted by State: https://www.cancer.gov/research/infrastructure/cancer-centers

Best wishes for success on your journey with PCa.