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Almost 9 years post RP - PSA creeping (SRT?)

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Posted 5/18/2021 9:39 AM (GMT 0)
Hi, back in 2012 my boyfriend had is prostate removed. Pre-op PSA was 4.1 and Gleason 3+4. Post RP, path was clean... clear margins, both seminal vesicles and lymph nodes negative. All was well. Fast forward to this month and his PSA is .13. Up from .07 in Nov 2020. His PSA had been .05 for a couple of years prior to the ,07. We are exploring SRT options. Needless to say he is aggravated. He did have some continence issues post surgery that we had a sling put in to help with. It didn't eradicate the problem, but definitely made it livable. We don't want that to worsen again. A couple of question for the guys who had SRT.

1. Did you opt for ADT with the SRT? If so, what were side effects? He does not want the ADT.
2. What was your radiation dosage level and for how many treatments over what time period?
3. How is your quality of life post treatment? Any recurring, long standing problems?

Thx in advance!
Teddydog
Posted 5/18/2021 11:28 AM (GMT 0)
Today there is much better imaging than 9 years ago, Before he gets SRT he should get a PMSA PET scan. It is possible the tumor producing his PSA is not even in the pelvis or outside the radiation field in the pelvis. If that is the case it can be spot treated with radiation vs blasting an area without cancer.

Post Edited (Duck2) : 5/18/2021 7:33:32 AM (GMT-6)

Posted 5/18/2021 2:30 PM (GMT 0)
Teddy dog, I ad SRT 3 years post op when my PSA after a long slow creep up, hit .08. To answer your questions…
1. I had ADT FOR 6 mont(s. It wasn’t fun, but very manageable.gained some weight around the middle, hot flashes, that was about it. I did ADT at the advice of my RO. Keep in mind everyone is int when I comes to Sid effects
2. I had 40 doses, oral 80 Grys, if I reckless correctly
3. No effect at all on my QOL. I leaked a bit for a short while after treatment, not enough to have to wear a pad, and it quickly resolved.
Posted 5/19/2021 1:49 AM (GMT 0)
teddydog - I had adjuvant radiation (ART) 5 months after surgery without ADT since my PSA was <0.10 and studies have not shown an advantage in that situation. It is something to discuss with his RO and weigh the overall benefit vs. short term side effects.

My dosage was 67Gy in prostate bed area for 37 treatments.

No long term effects of radiation after 2 years that I can trace back to treatment. I had the usual side effects of some increases urgency after treatment with extra tiredness near the end of treatment and for some weeks after completion. Keep in mind when surgery and radiation treatment are done in close time proximity, it is difficult to know what causes what. Radiation certainly extended some of the post surgery effects to my GI and urinary tracts which would not be applicable to SRT years later.
Posted 5/20/2021 6:41 PM (GMT 0)
Thx for the replies. We go to RO tomorrow.
Posted 5/20/2021 8:48 PM (GMT 0)
Hi Prato. I clicked on the "my story" url in your sig. and got an error message.

Djin

Missing Key Value : en-US, 736

Posted 5/21/2021 2:17 AM (GMT 0)

DjinTonic said...
Hi Prato. I clicked on the "my story" url in your sig. and got an error message.

Djin

Djin thanks for the reminder. I try to edit and update my signature last week and saw that The link you mention wasn’t working. I’m trying to figure it out will work n it and let you know when it’s fixed.
Posted 5/21/2021 6:00 AM (GMT 0)
Teddybear...over treatment advice is rampant on this forum for Pca..just my observation after seeing it happen over and over and did I say over...the last 12 years posting on this forum...logo...a voice crying in the wilderness caveat emptor...no mas...no mas...Stop Stop...do you want to be healed...jump the shark...crack the code...go...play have fun...dying with Pca...not from it...balderdash...dying is dying...living is living...Iiving is not an all or nothing situation...living is all... dying is nothing ...regards logo...the forum resident's Village Idiot...glory....No response will be given...the post is a statement not a question...nor subject to one....Tah Tah
Posted 5/21/2021 10:57 AM (GMT 0)
Hi teddydog. My hunch is that the RO will want to monitor his PSA for a while to see whether it continues to climb and, if so, at what rate. If it turns out to be BCR, having it start so many years after surgery is better than soon after. A slow rate of climb would also be better. Having a plan is good. Keep us posted, please.

There is always uncertainty in the right-most digit of any lab test.

All the best,

Djin
Posted 5/21/2021 12:24 PM (GMT 0)
Teddydog, I am in the same boat. My PSA became detectible 8 years after prostatectomy. I am currently in consultation with my Urologist and a radiation Oncologist. Currently my PSA is 0.12, the plan is to have 8 weeks of IMRT starting in late June without any ADT.
Posted 5/21/2021 1:01 PM (GMT 0)
Mine also started creeping up after about 7 years. Hit the .2 mark and was in talks with Oncologist then it dropped to 0.18 a few months ago then 0.16 this week. Hoping for benign tissue. Best of luck!
Posted 5/23/2021 9:17 PM (GMT 0)
Hi all. We met with a fantastic RO here in NJ. Dr. James Wong. One of the top RO's in the country and a pioneer in radiation therapy. We all agreed that we are moving forward with SRT w/o ADT. We'll be starting in June. For this interested and live in the area, here is Dr. Wong's biography...

https://findadoctor.atlantichealth.org/provider/James+R+Wong/640799

Will keep you all updated as we move along.
Posted 5/23/2021 10:47 PM (GMT 0)
Teddydog, am I correct that the RO didn't advise adding ADT rather than your boyfriend nixing It? The RT should knock out the likely scenario of local recurrence. And if there is any recurrence that is non-local, that can be dealt with later. ADT now would be overtreatment for his history, IMO.

Djin
Posted 5/23/2021 11:28 PM (GMT 0)
Djin, ADT was nixed by my boyfriend, but just an option from the RO. It's a 10% additive benefit right now. I've done some research on it as well. The RO did not indicate that it was mandatory at this juncture. Gave it as an option. Gave the upside vs downside. My boyfriend opted to leave that for later, if he needs it. We were all comfortable with that decision... the RO and us.
Posted 5/23/2021 11:31 PM (GMT 0)
Glad you found Dr. Wong and are happy. He is always easy to reach. Just dial the Wong number.
Posted 5/24/2021 9:42 PM (GMT 0)
Teddy, if you knew in 2012 that you would be having radiation now, would you of still have gone with surgery.
Posted 5/25/2021 1:11 AM (GMT 0)
If you could be a plant, which one would you be?
Posted 5/25/2021 12:23 PM (GMT 0)
62gal... yes, my boyfriend would not change a thing. We had a 9 year respite of no cancer. Yes, it is a bummer to have a biochemical recurrence at this point, but the PSA is so very low. At least we have a 2nd option... once you have radiation, you cannot radiate again or have surgery. We knew 100% what the pathology was after surgery... no guessing. We wanted that. In addition we had a friend who suffered greatly with long term radiation issues from a primary treatment of PCa with radiation. It's all good. My boyfriend was originally treated at 64. He is 73 now. We are comfortable with the RO. We were comfortable with the surgeon as well. We are hoping this puts an end to it, but if we get another 9 years respite, that's ok too. He is not going to die from this... it's an annoyance we'll deal with.
Posted 5/25/2021 1:54 PM (GMT 0)

teddydog said...
62gal... once you have radiation, you cannot radiate again or have surgery. ...

Here is a review of post-RT salvage treatments:

A review of salvage treatment options for disease progression after radiation therapy for localized prostate cancer (2019 Review, Full Text)

"...
Local treatment might be able to salvage 50% of patients with local recurrence
...
We review the relevant literature on available salvage treatment options and appropriate patient selection for patients with recurrent prostate cancer after RT. We report on the efficacy and adverse effects of the currently available local salvage modalities including salvage radical prostatectomy, high dose rate and low dose rate brachytherapy, cryotherapy, high intensity focused ultrasound, and stereotactic body RT. We additionally discuss diagnosis of oligometastatic disease on imaging and current approaches to treatment with either radiation or surgery. While a full review of chemotherapy and advanced androgen therapies is beyond the scope of this article we briefly discuss their use in the treatment of newly diagnosed recurrence after radiation."

[Emphasis mine]

Djin
Posted 5/25/2021 7:37 PM (GMT 0)
With any cancer treatment, there is always the 'what if' that floats around. We, all of us, make the best decision we can at the time, with the available information, and then roll with it. And, it's a rare cancer patient who doesn't sometimes go down the rabbit hole of--did I make the right call? Especially when things start looking challenging. Asking if he made the right decision 10 years ago based on what is happening today is a bit...looking for justification for one's position, perhaps?

A decision 10 years ago is that. It's done, it's past, and acceptance of the outcome is what is required. Regrets don't help. I'd say 9 years of good results is as good as it gets.
Posted 5/25/2021 9:56 PM (GMT 0)
If you could be a plant, which one would you be?

A dummy plant which you can relate too.
Posted 5/26/2021 1:25 AM (GMT 0)
Best of Luck with the treatments - my wife is an RN at Morristown Medical and Dr. Wong is very well respected. We went with Dr. Zablow who is with Garden State Urology / Morristown, though he is reducing his hours.

My surgery was with Dr Pressler after a consult/biopsy with Dr Perry Sutaria - both with Garden State Urology / Morristown
Posted 5/26/2021 2:15 AM (GMT 0)
62gal - you were asking a hypothetical question apparently in support of a pro radiation viewpoint. Her answer was good and should have been expected. I don’t like any cancer treatment.
Posted 5/27/2021 12:59 PM (GMT 0)

DjinTonic said...
Hi Prato. I clicked on the "my story" url in your sig. and got an error message.

Djin

Djin,.... fixed it. Thanks
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