Early Salvage/Recurrence Radiation Done! Next Steps?

Ok so I finished my radiation treatments. 68 Gy in 34 fractions....smack in the middle of Covid19 lockdown. 4/24 was my last session.

This is me by the bell.
https://stevesquickshare.s3.amazonaws.com/img_1855.jpeg

It was more emotional than I expected it would be. I was so amazingly grateful that the people at Fox Chase were there during this crazy COVID time (they don't get to work from home!) giving me a chance at a permanent remission. I couldn't thank everyone enough.I am going to miss the guys in the waiting room, the nurses, the security guard on the way in, the receptionists in the checkin area, the team that settled me into the machine each day and my weekly conversation with the RO (we talked about Covid more than my radiation....very very few side effects).

So I am still a relative newbie. My RALP was last fall, but I didn't get to undetectable (my last uPSA test in January showed 0.11). My pathology showed SVI+, Gleason 8. Mixed ductal and adenocarcinoma types. T3BN0M0. I am high risk.

My last 3 month injection of Lupron will be administered on May 7.

So basically yesterday they patted me on the back, scheduled a followup with the RO in about four months, and handed me a script for a uPSA test they wanted done just prior to that follow up.

Although I do have this disease. I consider myself lucky. My PSA was 5.5 at time of surgery (I sent my primary doctor a thank you note for screening my psa starting at age 45!) , and based on the pathology, it seems to have been just starting to break out of the gland . I have hit it with everything, and I really don't want to let up.

My questions are:
- When should I start my quarterly PSA checks? Do I really wait 4 months?
- Should I immediately transition my care to a MO? For example there may be future clinical trials people at my stage in this disease that I may qualify for/help with (even as someone in a control group).

Congratulations Stephen!

Last day of SRT was more emotional than I expected as well. 8 weeks of routine with great folks comes to a sudden end and you just sort of walk out with good luck wishes. I had a PSA check post SRT but while I was still on Lupron that confirmed T levels as well. My first post Lupron PSA will be in June. Was going to do one in March but decided against going to the lab.

Best wishes for your early action being conclusive.

You are correct, you really do develop a bond with those at the hospital, from the doc's, to nurses, to the parking lot guys,....... but it's real nice to move on. Good luck going forward!

Steve - Good to be done, the last day is somewhat anticlimactic as everyone goes on with patients and you are driving home.

I am using the standard PSA at 0.10 minimum sensitivity after RALP and ART. There is no benefit to knowing results below that threshold as nothing can be done now and I don’t want to know until it is time. I have just continued on the 3 month testing schedule since RALP and did not adjust when ART ended. My RO was fine with that just so he got copied on results.

Congratulations, Stephen. Here's hoping this will be the last PCa treatment you'll ever need.

about a year after my SRT, I transitioned followup to an MO. I'm glad I did. It's a relief to have already established a working relationship with the doctor who will provide future care if I need it. As a couple of forum members have observed recently in another thread, MOs seem to give their patients a lot of time, really get to know them and take an interest in their lives. My quarterly checkups include a thorough physical exam for enlarged lymph nodes or any other signs that the genie might be out of the bottle. If I have any concerns about what's next, I'm talking to the right practitioner. I feel well taken care of.

Your RO's plan for PSAs is fine. The usual protocol after salvage RT is to have PSAs every 3 months for the first two years; if no rise, then go to every 6 months.

Have you checked te MSK nanogram for SRT?

Stephen S said...
I did <check MSK nomogram> but it said that it was not appropriate for my situation (I never made it to zero from my RALP). So I couldn't answer questions about doubling time, time since RALP etc...

You can still run the MSK salvage nomogram. Ignore the descriptive paragraph at the beginning. Under "Additional Treatment Information" near the end, it asks "Did your PSA value obtained after radical prostatectomy remain elevated?" Answer Yes.

You're right about doubling time, though. With early salvage, it's hard to get an accurate read on doubling time, so basically you have to guesstimate.

I input your numbers using 6 months doubling time and came up with 52% chance of being progression-free after 6 years. Change the doubling time to 12 months and it comes up 63%.

Cyclone-ISU said...
Keep facing forward, and forging ahead!

Cyclone, I just wanted to say thanks. You have been very encouraging.

Post Edited (Stephen S) : 4/29/2020 9:52:08 PM (GMT-6)

Will keep an out out GG1273 ! Sorry that happened to you.

I have been drinking alot of water to make sure. things are flowing.

Agreeing with all the fellows who stated that drinking water is important, after radiation treatments.

Healthy hydration ... and to "keep the flow" going, so to speak ... well ... you know!

An interesting side note ...

My radiologist did not personally believe in running PSA tests in the middle of a series of radiation treatments, because PSA can actually SPIKE during radiation, if you've never had surgery ...

Meanwhile, my trusted oncologist wanted to "open Pandora's Box" --- just to see how my PSA was registering, in the middle of the nine weeks of radiation.

He vowed to keep it a secret, but he saw a favorable decline, and pretty soon, the "cat was out of the bag" --- and the decreasing number WAS an encouragement to me, the rest of the nine weeks.

My radiologist took a plan originally mapped out by the radiology department at Mayo Clinic, and zapped me with precise radiation.

As weeks and even months went by, my PSA crept downward, in little increments ... one-hundredth of a decimal point, at a time.

At long last, my PSA went down into the undetectable range --- and that's a far cry from where my PSA was at diagnosis.

45 radiation treatments --- whew ! I honestly didn't know what I could reasonably hope for, getting started ...

By the way ...

If I am EVER a contestant on WHEEL OF FORTUNE, I want my word puzzle to be the word U-N-D-E-T-E-C-T-A-B-L-E, when Vanna White reveals all the letters of MY word puzzle!

This-n-that,
CYCLONE - # Iowa State University