Options after Low dosed Pulsed Radation for Recurrent Prostate Cancer

Hello, i am lookin for feedback. My fathers PSA is rising again, after receiving low-dose pulsed radiation therapy at Fox Chase. its been six months since that treatment, at 3 months it was 3.0 and now at 6 months its 3.8.

this is the second round of radiation therapy that my dad received for his recurrent prostate cancer.

we are waiting to hear back from Fox Chase, but wonder whats next. we were hoping for a permanent solution, rather than hormone therapy. tho due to my dads overall health, we maybe limited with options.

thank you

my dad had IMRT initially. then the prostate cancer resturned last summer, then we tried Low Dose pulsed radiation in the fall. now it appears to have come back again too. the intent originally was to minimize any surgical procedures, so low dose pulsed therapy seemed like a good option.

my dad (73) has pacemaker and is on warfarin, so any surgery is a major undertaking. biopsy prior this round of radiation, only showed mild cancerous cells in a couple of cores. cancer seemed to be isolated to the prostate from imaging, however now i wonder if there are microscopic cells outside of the cancer that couldn't be visualized.

thanks for your response. i will have to dig back to see what fractions he had when he received IMRT.

he had a bone scan and PET scan last year prior to this round of radiation. both his medical oncologist and radiation oncologist were confident that the cancer was isolated to the prostate, since his bone scan and PET scan were negative. we were investigating axumin PET scan, but at the time that scan was not available at the VA.

I will be looking into other scans with different agents now.

thanks, we are suspect of PSA bounce too. still waiting to hear back from radiation oncologist about this result. we have an appointment with medical oncologist in early June. i expect they will want him to start hormone therapy.

thanks

First round of IMRT, the PSA was very low, undetectable for many years. then slow rose to around 2.9-3.0. then we did bone scan (negative), PET scan (negative), CT scan (negative) biopsy. biopsy showed 1 core was cancerous, and another core was suspicious. so, no tumors noted on any imaging. he then proceeded to get the low dose radiation therapy, at the 3 months post treatment, PSA was 3.0 (no change). so, we proceed to test again at 6 months, now its 3.8. so, it would appear that that treatment failed (my opinion), and there maybe cancerous cells outside of the prostate.

I am not sure how long a PSA bounce would occur for, i dont think its likely. but waiting to hear back from Fox Chase and the VA medical oncologist.

the good thing i suppose is its still relatively low, but I would like to find out the source of the tumor if it all posible.

JNF said...
What has been his PSA nadir (lowest point)? Ideally the PSA after radiation as a primary treatment should go below .50. A recurrence is defined as the nadir plus 2.0. If his PSA only reduced to 3.0 after his initial radiation, it could be indicative of systemic disease with PCa already outside the radiation area.

unfortunately this sounds correct to me. it's troubling that 3-month PSA was 3.

If it is outside the prostate bed and systemic then you are looking at management rather than cure. ADT is used to manage the disease and is not usually a cure. If his cancer is low grade and slow growing then ADT can work a long time. It could be curative but usually handled as management. Only time will tell.

sierraDon said...
my dad had IMRT initially. then the prostate cancer resturned last summer, then we tried Low Dose pulsed radiation in the fall. now it appears to have come back again too.

when you say the "prostate cancer resturned last summer" what was the PSA when this conclusion was reached? from last summer to now (less than a year) with a PSA of pushing 4 could be a very fast doubling rate depending on PSA when low dose was administered.

sierraDon said...
initial IMRT 2011
- low/undetectable PSA 2011 thru 2017
- 7/17 1.18
- 2/18 2.55
- 4/18 2.89
Low dose pulsed radiation 10/2018
- 2/19 3.0
- 5/19 3.8

the reading at 2/19 it was suspected that it was possibly bounce, however this reading this month proves it was likely not a bounce.

thank you. now I understand. looking at the big picture it appears the cancer was never affected by treatment.

thanks, the VA Medical Oncologist says they get concerned when the doubling is 6 months or less. currently the doubling is around 11 months. she requested that we repeat the PSA just to double check. i am meeting with her in two weeks then to discuss next steps, i want to find out if imaging is available with different contrasting agents that may paint a better picture.

the second radiation treatment, slowed it down for about a year. (the PSA stayed the same for about year at around 3.0) but yes there must something outside of the treatment area. i remain hopeful that a different scan will shed some light on this. and open up different options

as far as longetivity, my dad has this going on, and at some time in the future he is looking at TAVR to replace aortic stenosis impaired valve. he is being monitored now for that, with no plans set at this time.

Post Edited (sierraDon) : 5/24/2019 8:27:14 AM (GMT-6)