PSA levels after radical prostatectomy and eventual biochemical recurrence

Now there’s the dilemma, I suspect your on hormone therapy which whilst has it’s side affects can hold things at bay, could be considered if not already. If there are s metastasis  Then perhaps it’s growth could be slowed for a number of years

I recently had radiotherapy to prostrate bed suggested, although the psma pet scan didn’t show anything there so until convinced of benefit I think I’ll hold back. Perhaps your consultant can discuss pros and cons

Hi Troc

there is some info online about RT after surgery, either adjuvant or salvage. from what I have read some specialists like adjuvant RT, a kind of belt and braces approach I think. 

I can't see anything as to whether there are better results having RT  straight after surgery rather than waiting to see some psa results which might hopefully show that RT is not necessary.

As your Psa is low I would rather wait and see what happens in the next few months, if the Psa moves upwards then obviously have the RT at that stage because as u say there is always the possibility of more side effects to endure.

I presume that you r not on HT as u had surgery, presumably the tumour was well confined within the prostate?

best wishes

Steve

Hi Steve,

Thanks I agree with you.

I am not on anything at the moment as I have read too much.

The term salvage radiation is a bit misleading as some urologists say you should start radiotherapy if PSA starts to climb but not let it get above 0.2.

Munson in his book cautions to watch the rate of increase if any after its low point,but in my case if it went over 0.12 may need to do some new tests.

There are some people in Austria who will do therapy with Luthetium ,this seems to attach to cancer cells and can destroy them.(same isoptope as in psma)

It is experimental and generally used only when patients have done everything else but in Austria they seem to be willing to do it.

In Germany it is considered one of the last options.

We are not there yet but I would really love to know if anyone ever had a real decline in PSA after having say .1 or .08

I searched the net for people like this and did find one or two.

One wonders first if the bodys system itself can destroy lingering cells and one wonders if healthy prostate cells that may have been left behind can leave traces of PSA .

Nobody seems to have answers on that.

Thanks again

and keep in touch

Roy

Hi again and thanks,

No I am not doing any new therapy yet and do not really want hormone therapy.

I will monitor PSA on a monthly basis and if Covid relents a bit will seek out new urologists.

I agree on the prostae bed therapy,I will wait as I do not need new side effects.

The operation was already quite sufficient to show me what can happen and I am glad I achieved relative continenence so quickly.

I would like to talk to some really positive urologists and find out how many cases exist of PSA actually going back down after the first tests (not many I presume)

All the best for your therapy 

Roy

P.S

the tumour had started to bulge out of capsule  but final biopsy was R0.(no bones etc ,lymph nodes clear)

and margins of 200mm

Thats supposed to be good but was still advised to have radiotherapy as have Gleason 9

all the best

Roy

Hi Troc, If you read my profile you will see I had salvage radiotherapy alongside HT after biochemical recurrence following prostatectectomy in July 2015.

I was upgraded to T3a post surgery with intraductal involvement in additiion to adenocarcinoma.

My cancer was bulging on one side and had escaped. Despite this I had negative margins and PSA < 0.1 (I may have been at 0.08 but measurements were to one decimal place)

I was offered to be part of the radicals trial comparing ART versus SRT with a 50:50 chance of being in eaither camp.

I decided to wait until biochemical recurrence happened. This occurred just over a year post surgery.  An mpMRI detected cancer on the prostate bed but by then my PSA was at least 0.3. I had an F18 Choline PET scan when my PSA was 0.7 which detected more cancer at seminal vesicle remnants left behind after surgery. I immediately went on hormone therapy after the PET scan and had 55 Grays of SRT over 20 sessions three months later with the HT continued for a further two years because my PSA doubling time was fast at around 1.2 months. 

Because cancer was found on these scans my SRT was more targeted as well as including the whole prostate bed otherwise the seminal vesicle cancer would have been missed I think during SRT.

I have my next PSA test end of June.

Hope this is of some help.

I meant to add this link in too. Several studies have now shown that provided SRT is started early there are no major differences in further biochemical free recurrence (BFCS) between ART and SRT.

SRT versus ART

Only thing is, if SRT is started too early would it then become ART?

Hi yes

there are some studies suggesting this.

but there are also very traditional views.

Thats why the Munson book is so interesting.

all the best

I haven't read the Munson book. Must look it up.

Steve, ART is when you agree to radiotherapy quite soon after surgery and SRT is when you wait for official biochemical recurrence but I guess like you that there will be a crossover at some point!

It's a difficult choice. My oncologist wasn't keen to give me SRT as he was convinced I have distant micrometastasis but in the absence of any definitive evidence he agreed to SRT.

Time will tell, it causes me a bit of worry I must admit.