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PSA rising following RARP - what radiation treatment is best?

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Posted 6/25/2012 9:24 PM (GMT 0)
My husband had RARP in January 2012. PSA now rising from 0.1 to 0.4 in 2 months and radiation treatment recommended. I am confused at the array of treatments on offer: EBRT, IGRT, IMRT and proton beam therapy. I am wondering whether proton therapy would be best, but I don't think that it is offered anywhere in the UK yet. Our consultant has not even heard of it!

Has anyone had proton therapy following prostatectomy and can they recommend any doctors/treatment centres we could contact? Either in the UK or elsewhere.

Can this therapy be used if the prostate has been removed?

Any help/advice welcome as this is becoming a long haul of a journey in a very short space of time!

Jane
Posted 6/25/2012 10:16 PM (GMT 0)
here in the states, one of the more conventional external radiation sources would be a typical radiation solution for a failed surgery. i had imrt, that and igrt are very common choices here, depending on the radiation center. you say your psa has rising to .4, many experts feel its important to radiate before it hits .5, feeling its more effective. other experts say 1.x, but they are not the most common opinions.

i wouldn't not what choices you have available in the u.k. good luck to you, hope you find a suitable solution, and soon.

david in south carolina
Posted 6/26/2012 12:23 PM (GMT 0)
Hi Janem123- I just went through an interesting situation that you might check into for your husband.

My PSA went all the way up to .19 within 6 months of my RP due to benign prostate tissue left behind by my surgeon and now 1 year out my PSA is undetectable.

Maybe the same type of thing is happening with your husband. I would ask your surgeon how much prostate tissue he left behind. We tested this theory by putting me on Avodart for about 3 weeks and my PSA went down indicating that some or all of the PSA was being generated by benign prostate tissue.

It appears that your husbands surgery and post-op test results were really good with a gleason of 6.

Something to look into, if you have any questions regarding my particular case, please let me know.

Good luck for you and your husband, radiation after surgery can turn the tide on PSA if really needed, but nothing you want to do if you can avoid it.

Curt
Posted 6/29/2012 6:31 AM (GMT 0)
Hi Jane
I'm really sorry to hear that your husband's PSA has started to go up. As far as radiation treatment goes I think it is really important that you go to a hospital that is considered really good on its treatment of PCa. I don't think there is any other option on the NHS but to have standard radiation treatment. However there are numerous ongoing trials including IGRT and Cyberknife - your consultant should be fully aware of these or you can look them up on the cancer research website. Or what I would probably do in your case is go back to your GP and ask for a referral to one of the London hospitals such as Royal Marsden or Guys & St Thomas. You may be more likely to get on a trial then or in any case at least they have excellent radiotherapy departments. Just remember that it will involve daily treatment in the case of standard radiation so a good train line to London would be a benefit. Anyway hope this helps and keep me posted. My husband is 99% continent but still wearing a pad every day in case of accidents ! No positive news on the ED front - he has tried Cialis and Viagra and now been issued with a vacuum pump courtesy of the NHS. Next PSA test in mid August so we continue to keep our fingers crossed !
Hope it all goes well.
Alice
Posted 6/29/2012 6:30 PM (GMT 0)
Proton radiation is not really suited for salvage radiation. It's beam is very small, and to open it up to provide a "Full Pelvic" field is difficult..Here in the states, the latest LINAC's, Linear Accelerators, (Varian RapidArc) can deliver an effective dose with great precision and minimum side effects.. But first I would investigate Trimix's suggestion about benign tissue left behind...
Posted 6/29/2012 9:08 PM (GMT 0)
I'm just wondering, and I'd appreciate the viewpoints of other folks. I'm just wondering if the C11 choline and feraheme scans now kinda block the rush to salvage radiation. With a PSA as low as 1.0, the C11 test can now detect where the cancer resides. If it's local, or at least a focal metastasis, it could be treated with curative intent. Remove the rib, or take out the prostate, or zap the lymph nodes. Perhaps folks shouldn't jump to get salvage radiation, especially when combined with HT, which precludes such scans for quite a while.

I'd appreciate others' views. I may be way out in left field with this...

Nellie
Posted 6/29/2012 9:18 PM (GMT 0)

Fairwind said...
Proton radiation is not really suited for salvage radiation.

Actually, proton therapy can be used for salvage radiation in many instances. A good friend of mine had surgery at Johns Hopkins which failed within 18 months. Subsequently he had salvage radiation treatment at IU Health using proton therapy. He has had an excellent result so far, and wishes now that he had used proton as his initial treatment choice.

On the IU Health proton therapy website, salvage radiation is listed as among the conditions treatable with proton. See: http://iuhealthprotontherapy.org/conditions-treated/

It may not be suitable in all instances, but in many situations it can be an appropriate salvage treatment modality.
Posted 6/29/2012 11:34 PM (GMT 0)
I had the Ferreheme scan 8 weeks after failed surgery. Showed a lymph node. Now have 9/45 radiation treatments left at Dattoli in Sarasota. Cautiously optimistic. Doing 18 months of HT too.
Posted 6/30/2012 12:12 AM (GMT 0)
Jane,

I'm confused by your statement:

I am confused at the array of treatments on offer: EBRT, IGRT, IMRT and proton beam therapy. I am wondering whether proton therapy would be best, but I don't think that it is offered anywhere in the UK yet. Our consultant has not even heard of it!

When you say "on offer", I first think you are telling us that your doctor proposed those options, yet it seems that is not the case if it includes items your doctor is not aware of.

If you are simply looking at the various terms bantered around, it makes more sense. Here is a brutally simplified definition.

EBRT is external beam radiation therapy (RT). It is a generic term in the sense that all of what you mention is external beam. It is more significant if a facility used it to describe their system, because EBRT can mean modern and ancient. In it's "worst" application, it simply covered a box-shaped field, which would include other organs.

3D CRT uses computer software to better focus the beams

IMRT is intensity modulated RT. This is a type of EBRT that offers better focus of the radiation beam. This technology is still used, but is not state of the art at all.

IMRT is Intensity Modulated RT - a still more precise EBRT that allows better application of the radiation.

IGRT is Image guided RT - IMRT that uses additional systems to locate the target, and allow changes for very small movements of the organ. My IGRT used the Calypso system to be sure that the IMRT was focused each day correctly. My insurance considered it experimental in 2009, and refused to pay for the Calypso component.

Proton - a very precise RT that is intended for small tumors, but is also used for PCa. It is a much more expensive treatment available at limited facilities. My insurance would allow me to do it, but would only pay the standard costs for IMRT, which made it impossible for me.

So, EBRT is all of these. Ask for a little more detail if told "EBRT".

I suspect that if imaging tests can locate spots of PCa metastasis, Proton would be valid. If you are doing general prostate bed radiation just to "mop up", Proton would be likely just more expensive.

If the comparison were made without considering costs, proton is inviting.

Posted 6/30/2012 3:22 AM (GMT 0)
Hi Janem123,

When discussing options with your radiology team, I suggest you also discuss including: radiation to pelvic lymph nodes, and HT, that is hormone therapy to weaken any cancer cells prior tostarting radiation. This combination is the max; worth considering because this is the one best shot at a cure. If radiation fails, all the rest is delaying actions, albeit in some cases for years. Best wishes.

NewspaperLover
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