So many questions re Salvage Radiation

Hi Melanie,
Sorry your husband is headed toward SRT but you are doing the right thing by gathering as much information as you can. Here are my answers to your questions.
-I was 54 when diagnosed in 2001 and had open RP in early 2002
-My SRT was in 2010 and standards were different then than now. My urologist recommended SRT after my PSA hit 0.2 but by then it was increasing quickly. It was 0.4 at the start of SRT. Knowing what we know now, I would have started sooner.
-I was positive for SVI
-I was on Casodex for 3 months, starting a couple of weeks before start of SRT. Casodex was uncommon, most ROs use Lupron if they us ADT.
- I had one lymph node that was shown enlarged on pre-ADT x-rays. My RO targeted a portion of each treatment for the first 25 days at that node, which was the maximum he could do on that area without risking collateral damage.
-Total dosage was 66.5 Gy. I don't know the actual dosage given to the one enlarged lymph node.
-Nothing I know of done to specifically protect bladder or rectal wall other than the targeting of the radiation.
-My RO was a believer in Casodex, when possible, rather than Lupron because of typically lower side-effects. He is an outlier in this opinion in the U.S., though Casodex is more widely used in some other countries.

The SRT reduced my PSA to undetectable for four years. PSA returned in 2014 and I moved my care to an MO at Dana-Farber in 2016. I started intermittent ADT with Degarelix (Firmagon) in 2018. I've now been off treatment for about a year-and a-half and will start second round of ADT soon.

Even though my SRT wasn't curative, it bought me nearly 8 years before needing to start ADT, so I count that as a win.

Best of luck with your decisions and your husband's treatment.
Jim

Melanie, glad you are making progress and it seems like you've found an RO that really listens and gives you the time you need, which is important. Re your questions...

--How old were you when you were first diagnosed with PCa? - JUST TURNED 65
--What was your uPSA when you decided to have SRT? i.e., what was your "trigger" number? - DIDNT REALLY HAVE A TRIGGER, OTHER THAN WANTING TO GET IT DONE BEFORE IT WENT ABOVE .1. IT WAS .08 WHEN I STARTED
--How many years post-RP were you when you decided to start Salvage treatment? THREE YEARS (BECAME DETECTABLE 2 YEARS POST RP)
--Did your pathology report show positive margins? POSITIVE INTRA-OPERATEIVE, NEGATIVE FINAL
--Did you have ADT in conjunction with SRT? YES - MY CHOICE, RO GAVE ME OPTION, TOLD ME HE PREFERRED TO DO IT
--If you took ADT, for how long before starting RT? And how long in total? STARTED ONE MONTH BEFORE RP AND IT WAS A 6 MONTH DURATION
--Did you radiate the lymph nodes, too? NO ONLY PROSTATE BED - ASKED RO HE SAID HE DIDNT THINK NECESSARY TO DO LNs AND DOING LN's WOULD COME WITH UNWANTED SIDE EFFECTS
--What was the dosage they used for the prostate bed? 72 Gy's
--What was the dosage used for the lymph nodes (if they were radiated)
--Did they do anything to protect the bladder or rectal wall during radiation? NO, ONLY TO MAKE SURE I WENT INTO EACH TREATMENT WITH A FULL BLADDER AND EMPTY RECTUM. YOU ARE PROBABLY THINKING about SOMETHING LIKE SPACE OAR BUT THAT IS ONLY USED WHEN RADIATION IS PRIMARY TREATMENT
--Care to add any info/reasoning the doctors might have given you for any of the above choices? RO TOLD ME, WHEN ASKED TO QUANTIFY, THAT HE FELT ADDING ADT WOULD INCREASE CHANCE OF A CURE BY about 10%. HE ALSO STATED HE WOULD BE OK WITH MY NOT DOING ADT IF I CHOSE, AS LONG AS I STARTED TREATMENT BEFORE PSA ROSE ABOVE .1

Hope this helps in some way.

My PSA bounced around, up to 0.05, within 4 months of surgery. SRT, with six months of Lupron. Two world class docs told me I didn't need it, but given I had only one shot, I took it anyway. 70.2 Gy in 38 fractions (1.8 each) At most, I believe ADT improves odds 3% and that's very conditional on a case by case basis. Do some in depth research....there are more current studies.

Some insert a rectal balloon for protection during radiation. It's efficacy is debatable...like most things about prostate cancer.

Good luck!

Mel - I had ART and my stats are in signature.

67Gy over 37 sessions, no ADT with PSA <0.10 and my post-op data, small positive margin, prostate area only, no lymph nodes.

Full bladder and empty colon was all that was done to minimize effects. It was watched pretty closely and I got bounced a couple of times to drink more water and had to empty colon further one time without emptying bladder (clamp was given to me).

There are lots of treatment reasons based on all sorts of studies and doctor’s opinions. When you have a significant PSA rise after surgery, it is obvious that something significant should be done given his young age. The reasons for ADT, lymph nodes, and dosage will vary a bit between RO’s so don’t feel shy about contacting your RO with your concerns and questions.

How old were you when you were first diagnosed with PCa? 57

—what was your post-RP Gleason score?4+3, Tertiary 5

--What was your uPSA when you decided to have SRT? i.e., what was your "trigger" number? PSA was .10 when decided to take action.

--How many years post-RP were you when you decided to start Salvage treatment?: Started SRT one year plus some months post surgery.

--Did your pathology report show positive margins? No

--Did you have ADT in conjunction with SRT? Yes Lupron and Casodex

--If you took ADT, for how long before starting RT? And how long in total? Couple months before radiation 6 months total.

--Did you radiate the lymph nodes, too? No just prostate bed.

--What was the dosage they used for the prostate bed? 72.0 over 40 sessions.

--Did they do anything to protect the bladder or rectal wall during radiation? Nothing other than making sure bladder full.

Wishing all the best for your husband!!! (and of course you as well!).

Hey, Melaine,

My husband's post surgery pathology showed positive margins (Gleason 9). His PSA ever went below 10, so there was never any questions as to whether he'd have radiation. He did have ADT, which started about 3 months prior to the actual treatments. He continued ADT for 1 year, but only had about 4 months off before his PSA started climbing again. He's been on ADT for most of the last 6 years. There was nothing done to protect the bladder/rectum. The lymph nodes and prostate bed were radiated (72 gy over 40 sessions).

Donna.

Hi melanie

Here are my answers

How old were you when you were first diagnosed with PCa? 44


—what was your post-RP Gleason score?

3+4

--What was your uPSA when you decided to have SRT? i.e., what was your "trigger" number?

0.09

--How many years post-RP were you when you decided to start Salvage treatment?

1 year

--Did your pathology report show positive margins?

Yes

--Did you have ADT in conjunction with SRT?

Yes

--If you took ADT, for how long before starting RT? And how long in total?

3 months

--Did you radiate the lymph nodes, too?

I think so

--What was the dosage they used for the prostate bed?

70.5 gy

--What was the dosage used for the lymph nodes (if they were radiated)

Not sure

--Did they do anything to protect the bladder or rectal wall during radiation?

Told me not to move

--Care to add any info/reasoning the doctors might have given you for any of the above choices?

We thought this would give me the best chance.

I still alive btw... im typing this message as i think out these answers

Good luck!!!

--How old were you when you were first diagnosed with PCa? 61

—what was your post-RP Gleason score? G8

--What was your uPSA when you decided to have SRT? i.e., what was your "trigger" number? Undetectable. Treatment was adjuvant.

--How many years post-RP were you when you decided to start Salvage treatment? 2 months

--Did your pathology report show positive margins? no

--Did you have ADT in conjunction with SRT? yes, Lupron and Casodex

--If you took ADT, for how long before starting RT? 2 months

--Did you radiate the lymph nodes, too? Blasted the nodes. There is a Yale formula for positive mode risk. At 20% some ROs blast the nodes. It is controversial because if it is in the nodes locally there is a chance it has spread systemically. Horse out of the barn.

--What was the dosage they used for the prostate bed? 79 Gy, Yes aI flow at night.

--Did they do anything to protect the bladder or rectal wall during radiation? just a full bladder