SRT done and countdown begins

Hi Onestepforward , thanks for keeping us updated and hope you get good results soon.  The waiting is the hardest part I think.  Best wishes, David

Hi Onestepforward.

Many thanks for your update it's great to hear how things are going with you.

Yes getting things out of the NHS can be very difficult and frustrating at times I do leave it to my wife as she is known as the "Rottweiler" within the medical circle.

I really do hope that you have good news in August!!!

Prostate Worrier.

Good Evening Onestepforward 

Thank you for the update - I am so sorry that you have had to have further treatment after surgery but all looks good now. A couple of things:

* I always advise Community members to use the NHS App and ask for FULL access to your medical records on the app. It does help in finding out test results and quite often before you are aware of them from your team.

* I thought after Radiotherapy your "nadir" (lowest) reading was 18 months after the radiotherapy had been completed as it keeps on working for a period.(I have been wrong before!!).

I look forward to hearing from you again in August.

Best wishes - Brian.

Hi Millibob

Regarding the PSA reading, you make a very good point. In fact, to be totally honest I don't know if my PSA will drop to undetectable in 3 or 6 months....it's more a wish and I haven't been definitively told so. I think you are probably right.

Is there anybody out there who have had SRT after surgery and can share how their PSA reacted and how quickly?

Thanks  

Hello Onestepforward 

I thought I would look at the literature to try and answer your question about PSA levels after salvage radiotherapy and the indication is that there is little available. With salvage radiotherapy they appear to be looking for a rapid PSA decline both during and soon after completion of the course. The higher the % drop from the value immediately prior to salvage radiotherapy then the better the predicted outcome of a cure. The slower the drop then the greater the chance of biochemical recurrence later on. The seminal vesicle invasion may be a predictive marker.

https://bmcurol.biomedcentral.com/articles/10.1186/s12894-023-01323-5

I have also found this which indicates that the median nadir is around 3 to 4.89 months (range 1-21 months).

https://jnm.snmjournals.org/content/60/2/227#:~:text=The%20median%20post%2DsRT%20PSA,%E2%80%9321%20mo)%2C%20respectively.

This study outlines the benefits of a PSMA PET CT in providing more targeted extent of radiotherapy even when initial PSA levels at post prostatectomy recurrence are low. I think the question to ask is what exactly has been zapped?

Hi AH and Brian, I have been puzzling about the nadir in PSA at 18 months and concerned because , for my husband, the lowest reading was 3 months after radiotherapy ( the Rt and HT route and not surgery. We have been told to expect a PSA slight increase at the next PSA  reading due to cessation of HT.

the paper to which AH points refers only to men who have had salvage radiotherapy after prostatectomy and the average nadir seems to be 3-4 months.

So, is the PSA nadir usually different for surgery + salvage RT from RT +HT?

I also note ( if I have read it correctly) that the paper suggests that 30% of patients who have surgery go on to RT?. Is that correct? It seems a high number?

is there a big variation in PSA nadir times between all men, irrespective of treatment pathway?

I don’t have time this morning to read the paper fully, I’m afraid and I am not a scientist! 

Just thought I would give our resident scientist (AH) something to enjoy looking up while soaking up the sun rays - of which we are decidedly short of over here in the UK this summer   !!!!!!!!

I knew this question would come up WW so I had already started looking.

Yes, there is a difference between radiotherapy as a first line treatment compared to post surgery.

If you are on HT then ideally the nadir should be reached within 6 months of completing radiotherapy as a first line therapy. The faster the nadir is reached the better the prognosis with regard to biochemical recurrence. The radiotherapy will continue to work for 18 - 24 months but could be as long as 36 months in both sets of men as well as those having radiotherapy after surgery. The nadir figures for the post surgery men are independent of HT, but the addition of HT can improve outcomes particularly for those who exhibit spread after histology or on a PSMA PET CT scan. For those not on HT then the nadir for men just having radiotherapy 1 st line treatment takes longer with 18 months being the average time. A PSA bounce can occur, usually between 12 and 18 months but the level of the bounce should be small - this is more likely to happen in patients who have had Brachytherapy or SBRT. Please remember this is just my interpretation.

I have read figures between 20 and 50% for the number of men needing salvage or adjuvant radiotherapy after surgery. More is being done to identify the driving factors in this but initial PSA, Gleason and post surgery histology seem to be major contributors.

We are in the middle of another heatwave at the moment and have had 3 days reaching 41C in the shade in the last week so you are welcome to take your fair share of it in the UK.

https://www.pcfa.org.au/news-media/news/psa-levels-after-treatment-all-you-need-to-know/#:~:text=After%20radiation%20therapy%2C%20PSA%20levels,for%20cancer%20cells%20to%20die.

Hi 

i knew I could rely on you, AH 

thank you for the clarification. Our oncologist told us that with readings of 0.03 and 0.06 the movements are so minimal that accuracy is not always guaranteed ( at this level), PSA does tend to ‘bounce around a bit’ and there is no need to worry. 

I am surprised by the percentage of men having surgery who need to go on to RT  and possibly HT. I know there are no guarantees with either route but, do you know what percentage of men going down the RT and HT route ‘with the intention to cure’ have a recurrence?

Finally, many apologies to Onestepforward for somewhat side tracking your post. I really hope that things go in the right direction from now on. It all sounds as if you’ve had a tough time.

Hi WW.

This has been more difficult to try and pin down but one study suggests it could be higher in the RT arm compared to the surgery arm 30 - 50%. Another one says it is equivalent. The same prognostic features of initial PSA (preferably below 10), Gleason 7 or lower, histology (contained), as well as time to PSA drop after completion of radiotherapy plus level of drop play into the equation. Your husband has achieved the last two but I can't remember his other stats.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10024380/

Don't overthink, just enjoy your life.