Salvage radiation after surgery, when to start?

Winnie155 · June 22

The standard salvation treatments started when PSA reached 0.2 after surgery but I have read that some cancer centers started treatments when PSA reached 0.1. There is a fear of early treatments as they may caused more harm than good as the prostate is no longer there to shielded other organs. I have recently read the attached article and Wondering if anyone has been successful treated after reaching PSA 0.1 and remaining undetectable.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10250454/

Clevelandguy · June 23

Hi,

When you talk about the Prostate not shielding other organs the use of Proton therapy comes to mind. Proton has a fixed length beam and does not go past the intended target.

Dave 3+4

Josephg · June 23

The decision regarding when to start salvage radiation depends on the specific situation/case at hand. My surgeon was reasonably sure that the PCa had left the prostate when he extracted it, and so they decided to start salvage radiation, when my PSA reached 0.10 one year later (My first PSA reading post-surgery was 0.05).

Was the salvage radiation successful? It depends on how you measure success. I went 36 months after salvage radiation, before my PSA became detectible again. Since then, I've had SRBT radiation on a local metastasis in my pubic bone and 2 years on an aggressive hormone cocktail.

12 years after my initial PCa diagnosis, I'm still here and enjoying the quality of life that I've been afforded.

Winnie155 · June 23

Thanks all.
ClevelandGuy, I don’t know a lot about Proton but It appears that a lot of people have SBRT for salvage treatments. I will looking into it.
Josephg , that’s great to hear about your situation. It must be a really tough 2 years of ADT that you have had.

We would like to get second opinions about salvage treatments just in case if my PSA reached 0.1 later on as my doctors said they would not doing anything unless my PSA reached 0.2 . From what I have read, the BCR rates are lower if re treatments are done at .01 instead of waiting until PSA reached 0.2 or higher.

Josephg · June 24

https://csn.cancer.org/discussion/comment/1716200#Comment_1716200

In order to effectively treat PCa with SRBT, you need to know precisely where the PCa is located. That is why the 0.20 PSA parameter was established, as an MRI or even better, a PSMA scan, is more likely to actually see the PCa's precise location.

Winnie155 · June 24

Josephg- What did you have for salvage treatmentswhen your PSA reached .1 then? I was assuming that’s what you had. Someone I talked to received salvage treatments when his PSA reached 0.11. His doctor wanted to be aggressive with his treatments, but he opted out of ADT.

Josephg · June 25

https://csn.cancer.org/discussion/comment/1716223#Comment_1716223

When my PSA reached 0.10, my Oncologist put me on a 6 month ADT regimen with Lupron and Casodex. Then they started IMRT treatments to the prostate bed. 35 sessions, 68 grays of radiation. Yes, they were aggressive, but my cancer care center is aggressive with their PCa treatments.

Winnie155 · June 25

The standard is salvage at .2 and I think that’s too late. My doctor suggested PSMA PET at .2 and I am trying to get second opinions just in case. Did you have that scan before salvage treatments? From what I understand, it would not detected anything at that low PSA level so radiologists just radiate the prostate bed and lymph nodes.

Josephg · June 26

https://csn.cancer.org/discussion/comment/1716255#Comment_1716255

Yes, at 0.10, they did not perform any scans, as they were of the opinion that the remaining PCa was likely to be in the prostate bed, and my PSA was still too low to likely see any specific tumors with the scans. So, they went directly to irradiate the prostate bed.

Winnie155 · June 26

Thanks so much, Josephg . Wishing you the best of health and NED for life. I really appreciate your support by answering my questions as they have helped a lot.

Josephg · June 27

https://csn.cancer.org/discussion/comment/1716298#Comment_1716298

Any time.

That is what most of us are here for.

Arkman123 · June 28

One month after prostatectomy, my PSA was 0.01. Three and a half months later, it is now 0.24. I meet my urologist this coming Monday. I don't mind saying that I am freaking out. I thought the surgery would take care of it.

I'm 61 and otherwise in excellent health.

Marlon · June 28

Anybody know what the actual minimum detection limit is for PSA testing? That is, the lowest level that can be quantified and reported. I see PSA reported up to two decimal places, but wondering how low is "non-detectible".

Dan1959 · June 28

https://csn.cancer.org/discussion/comment/1716341#Comment_1716341

The Indiana University (IU) network labs use an Abbott Laboratories assay with a threshold of .008 ng/mL (i.e. undetectable is <.008). I bounce between undetectable and .010, the latter being within the tests margin of error. I believe newer tests exist that drop the threshold even lower (to.003).

Old Salt · June 28

There are two types of PSA assay. One is the 'regular' one; the other one is the ultrasensitive one. There are also at least two different instruments for the ultrasensitive assay. The one mentioned above (Abbott) and the LabCorp one. The sensitivity may vary juist a bit.

The ultrasensitive assay is most often used after prostate surgery.

Winnie155 · July 30

https://csn.cancer.org/discussion/comment/1716340#Comment_1716340

Have you received the salvage treatments yet? My husband’s latest PSA is 0.1 and I am so worried.

Arkman123 · July 30

https://csn.cancer.org/discussion/comment/1717032#Comment_1717032

No. It appears the PSA test was wrong because when I had another one run the result was back down to almost zero. So always run another test before making any decisions!

Salvage radiation after surgery, when to start?

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