Salvage radiation therapy after radical prostatectomy

It's looking like my doubling time will be under 12 months. We are still looking to establish that. My schedule PSA test next month will tell us more. My Gleason score is 7 and time to recurrance is approx 5 years so I'm on the edge except for doubling time which is looking maybe around 8 months. Time for recurrance of 5 years seems to be one factor possibly in my favor. My radiation oncologist tells me these cases don't follow a consistant path and that is one of the challenges in making these decisions. I'm 69 and fairly fit. I have been dealing with the typical incontinance issues of a couple pads a day and ED. The risk of total incontinence, rectal bleeding, bladder and those issues give me pause in wanting to take the salvage route even though I am considering any options. I know the cancer growth is relatively slow and with hormone therapy and chemo I could possibly have a number of years with basic systems still in working order and deal with those side effects later down the line. I'd like to think targeted radiation to metastases that could occur could be beneficial for at least a while. I wouldn't feel cheated if I don't reach the age of 90 but I'd be grateful for 8 to 10 more years.

Dear Fellow Journeyman...
You took words out of my mouth. I am in the same boat as you are and that's why I posted the question.

There are models that predict risk of distant metastases which includes
1. PSA - Double Time. If >12 months, low risk
2. Gleason score - 7 or below
3. If first rise after prostatectomy is after 18 -24 months.
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If person falls meets above criteria, they are considered low risk of distant metastases.
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There is normogram from Memorial Sloan Catering which one can do.

https://www.mskcc.org/nomograms/prostate/biochemical_recurrence
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We are in same boat. I would be curious to know what route to take.

Best wishes for your journey..Hugs..

I had radical prostatectomy in 2019 but now PSA is rising and currently at 0.4 so the radiation specialist has recommended salvage radiation to prostate bed. I am concerned with the potential after effects (morbidity) of the treatment. I'd like to know if there are those in the group that have decided to not go that direction for this reason and to follow obsevation and hormone thearapy using radiation for a more targeted approach as things may develop as well as the use of chemo. To risk quality of life in the early stages of the disease is a hard choice when there is a good chance the radiation may not have any positive effect. I'm not good at betting on the odds. I'm surprized that there aren't more disscussions on this. Any input??

My Salvage Radiation after RP was 37 treatments 66.6 gy delivered at fractions of 1.8 to the pelvic region with 25 of those treatments including the pelvic lymph nodes.

Radiation Oncology in general has been delivering different fractions over different periods of time through the years.

Best wishes

Usual dose is 66Gray (Gy) when they give 35 sessions.

I don't know what the power setting was - 22 sessions , instead of 33 though . What is the normal range for Grays ? I was fascinated at the equipment though . Get the crew at the hospital to give you a tour of what their equipment is like and process . The radiation rooms at Victoria Hosp was amazing though . Gave me confidence in process .

We have visited Victoria Vancouver British Columbia and it is one of the most beautiful places....
Glad to hear that your journey was smooth with minimal side effects...Plus you had good staff, food, accommodation, hiking and care provided from your tax dollars...Thanks for your feedback...

Samadhi, I dont know what the dose was . At the Victoria Cancer Clinic on Vancouver Island it is very modern. The tech was saying to me they have this new software that boosts strength and also has different patterns . Interesting technology actually. So I dont know the exact GY level, but it did the job well. Jumpy Bladder and bowel for a couple months and that was about it . After EBRT oddly the PSA was at 0.02 right away and then went back to 0.014 and stayed there for about 3 months , then started gliding downwards . The Dr's said this was usual . After 6 months I could really see a PSA drop . No ill effects on sexual health or other . The Dr's were. saying the usual dose was 33 sessions , but with their new software and the nature of my profile , 33 sessions were not needed and that 22 was going to be fine for me . I gather so far they were right ! I didnt have to wait at all for my radiation as I put myself on cancelation list . The Victoria Cancer clinic even had a room for me at their Cancer pavilion , as I live 1.5 hours north of Victoria on Vancouver Island . I have to say their accommodations were wonderful with cancer nursing support there and Doctors came around 2-3 times a day . I was out seeign the sights and walking most of the time . The food was terrific too ! All organic , and hand made . Totally free for us ( I guess we paid high taxes over the years for the service) . I spent 4 weeks there and went home on weekends . Great experience . I did leave them a tax ductile donation of 1000 dollars though . The least I could do !

Radiation oncologist recommends 22 session of salvage radiation therapy to prostate bed. My PSMA PET scan was negative which was done last year.

Threshold to start salvage radiation is when there are 2 consecutive PSA readings above 0.2

Glad to know that you had minimal adverse reactions. Did radiation affect sexual function?

Do you know how many Gray (Gy) of radiation was used?
Thanks

At 0.26 , you're under what a PSMA Pet scan would pick up I think . What does doctors say ? Do they feel like there is stray cells in Pelvic bed or ? I had 22 sessions - no chemicals . Bladder wa funny after the 22 sessions for about 2-3 months , but that was about it . I went from PSA 0.14 to now 0.056 over the last year . it takes times for the external Beam radiation to work ....but it does . I had no PSMA Pet scan before my radiation as at 0.14 its too low to get accurate reading for scan . Dr's felt it was in prostate bed , some stay cells producing PSA . I recommend EBRT for sure at some point after surgery . Adverse effects are minimal.