What tests and scans were ordered before you had your salvage RT ?

@surftohealth88 I had RP surgery 11/11/24 and my Gleason also went from 4+3 to 4+5. PSA was at 0.02 after 8 months, and 0.04 after 11 months. Even though it was still low we decided to move ahead with radiation because it was trending the wrong direction. I had a single Lupron shot in October 2-25 and 39 radiation sessions from 12/8/25 to 2/4/26. As of 2/18 my PSA was <0.01. My only side effects were fatigue from the radiation and hot flashes from the Lupron. I'm getting my energy back but the hot flashes continue. I'm feeling good about the process so far. My next appointment with radiation oncology is in early July.

@surftohealth88 As soon as that PSMA is done and read ( negative!) get him on the Orgovyx/Nubeqa(?)
ASAP. You’ll be able to put the brakes on right away.
Phil

@pamperme
Thanks Timmy so much for finding time to give me additional details and an update about your treatment 💗 My husband is in very similar situation, one iffy margin, Decipher 1 (the highest that exists) and his pathology after RP was updated from 4+3 to 4+5 😔. Cribriform and IDC on top of it all... Our "doctor team" is not proactive (even though my husband is treated in a big cancer center of excellence in the Bay Area, CA ) so we have to fight for every single step taken. His uPSA climbed from less than 0.014 post op to 0.136 now (9 mos post op) and they do not see it as "urgent" which blows my mind !!! I feel like I live in some parallel universe where high risk BCR is "nothing to worry about" (??) Every single study shows that treatment should start at 0.25 the latest and his doubling time is less than a month ! We finally managed to get orders for some tests and some we did on our own. PSMA was scheduled for June 8th which would possibly push my husbands PSA in 0.5 territory 😵 so we had to call around and make app. in different hospital that had a sooner opening : (((. All in all, thanks again for all the details since we have to basically make my husband's sRT plan and protocol by ourselves : (((.

Sending healing vibes your way : )) !!! You are half way done and are in very competent and caring hands 👍 - just little bit more and you will be done with this all : )))) ! Wishing you all the best <3

@heavyphil

Hey Phil : ) , yes that is a plan. He picked up Orgovyx from their pharmacy just the other day and now the next step is PSMA this Thursday 🍀 and after that he can start with ADT.
We asked for Nubeqa and we were told that it is not approved for sRT yet 😞, they are waiting for results from phase III trial that will come out this summer *sigh . I mean, how it would NOT help (?), right ? But what can we do. We were not offered any other meds in general. I guess our doctors are in denial that my husband has high risk cancer and that he truly has BCR happening - I do not know how to explain this ? We talked to MO, RO and surgeon. All 3 of them at first told me to "hold my horses" and now that I was proven correct about BCR they are still in no rush to start his treatment and his doubling time is less than 4 weeks !!! WTH ? The only other place that has high ratings is Stanford, but at this point I doubt that they are so much better. My husband is still working so we can not travel for treatments to some other city either : (((, all in all, I might save my husband at the end, but I will end up pushing daises myself very soon due to all this stress... *sigh

When my salvage radiation was done in 2019 by Dr Sean P. Collins (one of the best) at Georgetown Medstar it was done without what's available now. Still got a great result with recurrence later only outside of the area he treated

Today with new scans authorized (from AI on the subject)

Before proceeding with salvage radiation, a comprehensive workup is used to determine exactly where recurrent cancer is located. PSMA PET scans (which map out a protein on cancer cells) and multiparametric MRI (which details soft tissues in the pelvis) are the primary imaging tests utilized.

These tests work together to pinpoint the location of the disease, guiding your radiation oncologist on where to target treatment.

1. PSMA PET Scans

Prostate-Specific Membrane Antigen (PSMA) PET scans have become the gold standard for detecting recurrent prostate cancer.

• How it works: A radioactive tracer is injected into the bloodstream, which then attaches specifically to PSMA proteins (which are highly overexpressed on prostate cancer cells).

• Role in salvage therapy: It detects whether the cancer is confined to the prostate bed, has spread to nearby pelvic lymph nodes, or has metastasized elsewhere in the body.

• Advantage: It is highly sensitive, meaning it can detect tiny clusters of cancer cells even when PSA levels are still very low.

2. Multiparametric MRI (mpMRI)

While PSMA PET is exceptional at finding cancer anywhere in the body, MRI provides unmatched anatomical detail of the local prostate bed and surrounding pelvic organs.

• How it works: Uses strong magnets and radio waves to create highly detailed images of the soft tissues.

• Role in salvage therapy: It maps out the exact anatomy of the area where the prostate used to be (the prostatic fossa) and nearby structures, helping radiation oncologists avoid vital organs while focusing the radiation beam.

In many modern centers, these two technologies are merged.

• PSMA PET/CT: The standard setup where the PET scan (functional tracking of the cancer) is combined with a traditional CT scan (anatomical mapping).

• PSMA PET/MRI: A hybrid scanner that combines the functional tracking of PSMA PET directly with the highly detailed soft-tissue anatomy of an MRI. This allows clinicians to co-localize suspicious PET uptake with precise MRI tissue characteristics without having to undergo two separate scans.

Accompanying Tests

Before determining if salvage radiation is the right path, other standard clinical tests and labs are usually performed:

• PSA Blood Test: A continually rising PSA level (biochemical recurrence) is often the initial trigger that prompts these scans.

• Testosterone Level Test: Checked to ensure hypogonadism (low testosterone) is not masking the true nature of your PSA numbers.

• Digital Rectal Exam (DRE): Used to physically feel the area where the prostate used to be for any palpable nodules or irregularities.
GOOD LUCK!!!!

@icorps I meant to post this here in the reply section

Thank you so much for this. I have it printed out to use when I see my oncologist
Ed In Maryland

.014 up from .006
I am seeing an oncologist two Fridays from now.She has already ordered some tests for me I am going to use the sheet from icorps to see which one she orders
Thanks for asking I hope you and your husband get some good news and good treatment