Post Surgery IMRT Decision

I had open surgery in October.  Seminal vessels and lymph nodes clear, two small positive margins and a PSA of .07 done with ultra-sensitive method.  Urologist referred me to radiology oncologist who will talk to me again after 90 day PSA test result in January. He stated that current feeling is that post surgery IMRT should be done no later than the 6 month mark for best results.  It seems like most men and their doctors are happy with a PSA of <.10.  I brought that up to my urologist in latest meeting and he said that it was confusing and that my hospital lab will no longer be using the ultra-sensitive test.  So I would assume that my 90 day PSA will be <.10 (hopefully).  Unfortunately that will not tell me if there was a rise in PSA from the 30 day result.  I really don't want to do IMRT and deal with susequent side effects if I don't have to because I am still dealing with mild incontinence and hard core ED from the surgery.  My question is for those of you who chose to have IMRT after surgery, was your decison based on a rising PSA (>1.5) or was it based on positive margins being present.  My urologist is leaving the decision up to me and the radiology oncologist seems to be inclined to do the IMRT no matter what. 

Thanks.  Definately a retired squid.  Was really shocked with PC diagnosis because over the years I believed that San Miguel beer consumed in large quantities prevented all diseases!!!!

Hi SubicSquid,

The issues about ART or/and SRT are a little unclear..........like everything else about this darn cancer. In my case, the PSA numbers started to creep up about one year after my open RRP. At the two year mark post RRP, it was about 0.08 and at SRT start had risen to 0.1. It is my understanding that the chance of success is best when RT is started very early. My Surgeon, my Onc and myself agreed that to start SRT at 0.1 was my best and only chance of beating the beast. My side effects from the RT were minimal and early indications are that it may have been successful. Time will tell.

Wishing you all the best in your journey.

Magaboo

Squid, another ex navy guy here. Drank my share of San Miguel in the PI back in the days.

I just went through salvage IMRT. Mine was based on 3 consecutive rises in PSA post surgery and the fact that I had one positive margin, and due to my high velocity PSA pre-surgery.

Of course the radiation clinic would like to have you, they make a lot of money off those long treatments. Mine ran close to 3,000 a day for 39 days.

I would make sure you have bonifide reaccourance first, before taking that next step.

If you are <.10, wouldn't give it a thought.

David in SC (formerly with VP-17 and DEG-6)