Further treatment?

Hi Spursy

I don't have experience of this but I know there are a couple on here who do, hope they post.

They probably can't do targeted therapy because not much would show on scans with PSA at that low level.

See what they say at oncology when u next go.

Best wishes

Steve 

Hi Steve, 

Thanks for the reply, it was my nurse specialist who mentioned possible targeted radiotherapy but I guess I'll just have to wait until oncology believe it's gone far enough to warrant treatment. I haven't heard from them yet so I'm assuming they are going to wait for my next psa in April. 

Yes, something we all dread after treatment, a rising PSA, I have  a PSA in a few weeks.

Hope all goes well, let us know 

Steve 

Will do  keeping my fingers crossed for you. 

Your PSA was never very low after the prostatectomy and has steadily increased, so this suggests some prostate cancer was left behind.
Did you have positive margins? If so, it's most likely in the prostate bed.
If you had negative margins, then it may be somewhere else, in which case I suggest you ask for a PSMA PET scan to find where it is. They will probably wait until PSA is at least 0.2 or 0.5 before doing a PSMA PET scan, or it may be too small to show up on the scan.

If it's in the prostate bed, they'll probably do around 34 radiotherapy sessions (one each weekday).
If it's somewhere else, they might offer SABR radiotherapy (usually about 5 sessions, maybe one each day or every other day), depending on the position and number of locations (up to 3). Not all treatment centres offer SBRT or PSMA PET scans, so you might need to ask to be referred elsewhere if you think you need these procedures.

If your surgery was non-nerve sparing, then the radiotherapy can't really make ED any worse. You will need to use penile injections or Vitaros or MUSE or a pump for erections (regardless of the radiotherapy). You might also be eligible for a penile implant if those don't work for you. It is worth testing occasionally with Sildenafil or Tadalafil - these won't work without nerves, but just occasionally some nerves were spared when the surgeon doesn't think they were, because the nerves (which aren't visible by eye) followed a different route.

Hi Andy, 

Thanks for the reply and the wealth of knowledge, the cancer had reached the outer surface of my prostate which is why the non nerve sparing option was used by my surgeon,  I will definitely be taking this information with my when i finally get the call from oncology,  I am currently using a pump for my ed and am halfway through ruling out Tadalafil after  unsuccessfully trying Sildenafil, are you suggesting to periodically re trying these again in the future?

Thanks again 

Lee

Hi Lee, continue using the ED drugs. You probably notice the effect with some extra blood flow down there. This is good for tissue health. Having success for you at this point is a long shot but some see improvement after a year and beyond. Are you having any side effects from either drug?

Hi, thanks for the reply, banging headache on Sildenafil, similar on the Tadalafil but last time took painkillers before going to sleep and the next day was far better than without, I'll persevere for a while yet, ed clinic has said injections is the next step, I'm not sure i like the thought of those and might just stick to the pump although it would be nice to find a workable alternative to it