Not What We Were Hoping For

Thanks again Djin for being the voice of reason. I appreciate it.

Hi Mumbo,

We actually have Aetna open Access and can see any specialist without a referral. Our issue has been that specialists will not see him without a referral, which makes things more difficult.

Thanks Stephen,

I read your signature and see that you had persistent psa after surgery and then a rise after radiation. I am glad to see that you are undetectable now and pray the trend continues for you. Are you being treated at a major cancer center? Thanks for the advice for my husband. This forum is a godsend to me.

Here is a German paper I was trying to find when I first posted:

Postoperative Radiotherapy of Prostate Cancer: Adjuvant versus Early Salvage (Full Text, 2022)

"Abstract
Results of three randomized clinical trials (RCTs) comparing adjuvant radiotherapy (ART) and early salvage radiotherapy (eSRT) of prostate carcinoma and a subsequent meta-analysis of the individual patient data from these RCTs were recently published. The results suggest that early eSRT is as effective and potentially less toxic than ART. Therefore, eSRT should be considered the standard of care. However, due to limitations in the RCTs, ART remains a valid treatment option in patients with the combination of high-risk features such as Gleason Score (GS) 8–10, positive surgical margins (R1) and pathological T-stage 3 or 4 (pT3/4). This article provides a critical appraisal of the RCTs and the rationale for recommendations adopted in the current national guidelines regarding patients with high-risk features after radical prostatectomy (RP): ART should be offered in case of pT3/pT4 and R1 and Gleason Score 8–10; ART can be offered in case of pT3/pT4 and R0 and Gleason Score 8–10 as well as in case of multifocal R1 (including pT2) and Gleason Score 8–10. [In any case, the alternative treatment option of eSRT in case of rising PSA should be discussed with the patient."

[R1 = Positive Surgical Margin(s)]

From the Full Text:

"5. Conclusions
No doubt, the recent trials tremendously contribute to high level evidence for the optimal care of patients and impact decision making for the majority of patients towards eSRT. These new data greatly improve patient selection towards eSRT in patients without multiple high-risk features and led to a reduction in “unnecessary” adjuvant treatments. However, given the above-mentioned limitations, several of which having also been voiced by the authors of the RCTs and the meta-analysis, the interdisciplinary working group within the German S3 guideline consortium has agreed upon recommendations for patient counselling in specific clinical scenarios where ART still appears to be a valid treatment option (Figure 2). These subgroups (no PSA persistence, nodal negative) include: ..."

(See the Full Text for analysis and discussion.)

Post Edited (DjinTonic) : 9/11/2023 6:40:00 AM (GMT-8)

Thank you everyone. We’ll see how it goes. My husband has a second opinion consult at Sloan Kettering at the beginning of October, and this week we are meeting with an MSK affiliated radiation oncologist who will follow the instructions of MSK in NYC. We have been very happy so far with Yale but my husband’s PSA just jumped to 0.10 from 0.06 in a week so there seems to be more urgency now. Definitely want to hear second opinions and be ready to act fast if we need to. I will keep you posted.

Mumbo, thank you. I feel reassured but watchful.