The right time to start radiation post RP with an increasing PSA?

My experience and my recollection of others who have posted would be to follow your Drs recommendations and begin salvage radiation treatment (SRT).
I had RP in Aug 2022 and my postop PSA was .19
Negative PSMA pet scan (which ruled out identifiable metastases w/in the limits of the scan's sensitivity)
WPRT w/ short term ADT Feb - June 2023 (IMRT radiation)
2 1/2 years undetectable PSA since completing SRT
My understanding is that in the absence of specific lesions, the thinking is that residual cells in the prostate region exist and need attention.
Best wishes.

@abinoone
One reason is that ASCO is not a group of laymen.

You are new here so you don’t know about what has been going on with people around the country when they get poor treatment. We see it frequently in this forum. People whose doctors have not followed the standards of care and apparently don’t know what the standards are. So following your medical team can be a mistake if you are not informed about what the standards of care are.

I not only participate in this forum, but I go to nine online advanced prostate cancer meetings every month. I hear stories all the time from people that have not been given the minimum required treatment, and as a result, have aggressive prostate cancer.

It’s fine to listen to your medical team, but it is better to find out what the required treatment is so that when you speak to your medical team, you are informed and can ask for what should be the standard of care.

A good example of this is oncologists. There are medical oncologist, whose treat all different types of cancer, but aren’t experts on prostate cancer. Then there are Genito Urinary Oncologists, Who specialize in prostate cancer and know all of the standards and the new things going on because that is their specialty. I frequently hear about people who are going to medical oncologist, but aren’t being treated correctly.

We see this happening frequently when people are given Lupron without First having Biclutamide For a couple of weeks. Then they get a testosterone flare that increases their PSA and makes their cancer worse for a little while, and maybe longer.. This is another one of those things that happens frequently, but if the people come here, they can be informed ahead of time. For some reason, not all doctors are aware of this simple requirement.

@brianjarvis Thank you very much. I did watch Dr. Kwons presentation and it was helpful as well. We haven't gone down the road of an alternate imaging other than the PSMA but I will ask that question today as I did take it to heart to not start unless you know where the cancer is.
Thank to you all the comments and I very much appreciate the forum to ask questions and get others advice and relevant experiences.

Your oncologist is correct - since you have had consecutive increases in PSA and are now approaching 0.2 - which is the definition of biochemical recurrence after prostatectomy, there really is no benefit or reason to postpone treatment - it just allows the remaining cancer cells to continue to grow, multiply and get stronger. If there is no definitive cancer identified through the PSMA PET CT, The radiation will be a wide field EBRT (external beam radiation therapy) to the pelvic area - with particular focus on the prostate bed and surrounding area (to treat any potential localized metastasis to the lymph system). They may also recommend androgen deprivation therapy (ADT) in conjunction with the radiation - the hormone deprivation in combination with radiation has been proven to offer improved curative results vs radiation or ADT done alone. Wishing you the very best outcome and lasting remission in the future.

@jeffmarc we can probably put this aside but I for one just wanted to say your expertise is invaluable. For one, everyone knows they need to go through there Dr for approval or find a new Dr. Prostate issues are not something you can go to Mexico and buy a pill. But to have the opportunity to get the experience you provide and all the rest of the members on this site is empowering. I go to Mayo clinic COE and have learned more about an AUS device from the "laymen" on this site. Pretty well educated ones at that. That prepared me quite well when I saw the Dr for my appointment. I think any new members will soon see the service you and others provide.

I had RP in November 2024. My Gleason score changed from 4+3 from the biopsy to 4+5 after surgery, with some adverse factors including bladder neck invasion. My PSA was 0.02 in June, 0.04 in September. While those are low, the trend was the wrong direction and we decided to begin radiation. I had a Lupron shot in October and began radiation in early December. I've had 20 of 39 radiation treatments. The rad onc recommended aggressive treatment and I agreed - no need to wait for a higher PSA when we know what's coming. Radiation is going well so far. Only side effect for me has been fatigue.

@jeffmarc with more aggressive features as my partner has, MO recommended to us yesterday at our first appointment to have him start Zytiga and Orogyx straight away and most likely 7 weeks of radiation. His PSA yesterday was 0.076 up from a month ago 0.072.

Would he want to wait a bit or start straight away because of the aggressive features his PCa has? Thank you

@anosmic1 Thank you for your info. Very much appreciated and helpful.

@esperling Thank you

@sriddle1
The problem is he does have an aggressive case of prostate cancer and, it is not a very big rise in PSA. The question is, does his case fit into the below guidelines for why someone should have Adjunct radiation, And not wait until PSA hits .2 for salvage radiation.

I know his Gleeson score is a nine so that hits one of the risk factors. Does he have one other of those below listed Risk factors?

I think this is something that @surftohealth88 Also was looking into. Maybe she can comment about why they decided to wait.

Adjunct radiation
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

Here is a link to the article supplied by @surftohealth88 originally
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