When to have Radiotherapy

Hello Peter (pete2000 ) 

You've done very well to get to 10 years without any intervention.

As your Gleason was an 8 (4+4) and although your PSA increases have not been rapid personally I think it would be a waste of time and NHS money having a PSMA-PET scan as at 0,2 it's only got about a 30% chance of picking anything up.

I think if you waited for the scan and it didn't pick anything up your anxiety levels may increase - I think I would just take the radiotherapy and hope it does the business - as you say age is against you now.

Best wishes - Brian.

Hi Millibob,  Thanks for replying.  It's a good nudge towards treatment.  I'm led to believe radiotherapy without a scan is just over 50% likely to succeed so I was reluctant to have it last time I met the oncologist.  But I'll be worrying about how long I can wait.  Thanks Peter

Hi Pete2000

I must admit if it was me I would be tempted to wait for another PSA as the last one was down slightly, it's taken a long time to go up , surprising as a Gleeson 4+4.

As has already been said pet scan may not show anything at that level of PSA.

Just my opinion obviously 

Best wishes 

Steve 

Hi pete2000 , I am not a fan of active surveillance but with your track record I think I would wait.  Your PSA isn’t showing the increase one would expect for a G8, so why bother starting treatment?  Unless a scan can identify a target, I think I would ride it out for a few years.  However, if you don’t think you could shut it out of your mind then that favours action sooner.  It’s a tricky decision but I am sure you will make the right one for you.

Hi pete2000,

I hope you had a useful meeting today.

I have been where you are now except my surgery was completely unsuccessful from the outset.

My PSA hit the 0.2 tripwire after just over a year and I have had salvage radiotherapy now.

I had a PSMA PET scan before RT and would not have been happy to proceed without one as whilst only about a 1/3rd of scans at PSA 0.2 show up any tumours I found it reassuring rather than a worry that none were found on mine.

I did not see the point of having RT to the prostate bed and its environs if there were tumours outside that area as the treatment would fail and I would have RT damage to add to surgical damage to the area with no benefit at all.

Also if one, or in some centres, two metatstases are found then they can be treated at the same time increasing the chance of success.

The 50% success rate you have been quoted is the lowest I have heard as my oncologists opinions were 65%, 80% and 85% which sounded surprisingly high which I hope turns out to be true.

The best results are obtained if RT starts between PSA 0.175 to 0.5 so you have a window of time yet that gives you time to consider what is best for you as the rise seems slow from your figures.

Whilst THE PSMA PET scan is said to be purely diagnostic my PSA dropped a little after I had mine which I took as a reassuring sign. 

I would be interested to know what you decide if you feel able to share your decision.

All the best

Albert

Hi All,  thanks for the comments. The consultant offered a wide range of treatment but said fairly emphatically she didn't recommend RT to the prostate bed as the rate of psa change was so low that I'd reach an age where hormones would keep me going to my life expectancy.  It was suggested I could also have hormones at some stage for 6 months then go off them for 2 to 3 years.  It made me nervous about the occasional step changes in psa but a psma scan is scheduled for late this year which was said to have a 50% chance of finding anything, although I've read less at just above 0.2, but I'll take it from there. 

I was torn at first but am fairly happy with this as it puts off any onorous treatments for several months at least to hopefully no long term effect.   Cheers Peter

That sounds ok Peter.

As you don't have a prostate gland anymore RT doesn't sound a great option cos where would u target it.

See what happens to the PSA over the next few months, hopefully it may stabilise.

Best wishes 

Steve 

Hi Grundo,

RT is standard salvage treatment for failed prostatectomy currently and is targeted on the prostate bed and surrounding areas.

One oncologist said its main focus was on the junction between the attachment of the cut urethra and the bladder as the prostate used to lie between those two structures.

It seemed to me to be a bit of a random blast but does seem to have decent success rates.

I chose a PSMA PET scan to see if it could focus more on where any remaining tumour might be to make it less random and therefore more likely to succeed.

Some oncologists suggest an extra blast at the area that used to be occupied by the tumour within the prostate but that makes no sense to me.

The prostate is no longer there and other structures must sag into its space and must slosh around a bit when you move so over irradiating them seems odd at least to me.

Best wishes

Albert

Thanks for the update Peter,

as I am affected by this situation would you mind telling me what the range of other treatments the oncologist advised as that could be useful for me.

Her advice sounds good to me and I am pleased you have a PSMA PET scan planned.

All the best 

Albert