In a quandary about when to start salvage radiation

Hello folks,

Well, I got my latest PSA back today. I am at .07, this almost two years since my surgery in June, 2011. To summarize the findings of my post-op pathology, I had a gleason score of 6 with extra prostatic extension and a focal positive margin. Total tumor load was 20%.

Earlier this week, I had my first consultation with a well-respected radiation oncologist in my local area. My latest PSA had not yet been received but he is of the opinion that there is no reason to hold off on starting salvage radiation treatment. He said my PSA history suggests a recurrence is underway and in order to stack the odds in my favor I should start SRT well before my PSA reaches .2. He feels that the odds of success drop off dramtically after PSA reaches .2 and that although statistically the success of SRT hovers around 50%, the findings of my post-op pathology and slow rise of my PSA would put me on the better side of that number.

Personally, I’ve accepted the fact that the need for SRT is a given; the quandary is deciding when to pull the trigger.

So here’s my thinking: I’ve been testing my PSA every three months since my surgery and plotted the numbers on a graph. If my calculations are correct, I shouldn’t reach .1 until around September of this year and reach a PSA of .2 around December of 2014. Based on those numbers, I’m thinking of starting my SRT in December after I get back from the GFMPH cruise.

Does that sound like a reasonable plan?

HD,

I am not your doctor, or anyone's doctor, but I don't see how they feel you have recurrence, you haven't even hit .10 yet, yet alone 3 consecutive occurrences above .10, as was the standard in my case. You are still technically undetectable. What is your doctors basis for calling .07 recurrence? It doesn't meet any of the other normal standards for recurrence either. Sounds like a rush to have you have radiation that you may or may not need, just my personal opinion.

I would think through this real hard, salvage radiation is a big step with its own risks, and I sure wouldn't vote for it without concrete evidence of true recurrence.

david in sc

Dave,

Like the doctor, I want to stack the odds in my favor as much as possible. The thoughts of getting SRT are scary enough; the thoughts of going through it for nothing are even worse. Both my URO and the RO agree that with my positive margin and EPE, the reason for the slow PSA rise is *more than likely* due to recurrence. Although the RO suggested starting SRT now (actually, doing the prelim stuff now with actual treatment starting in July when I get back from vacation), my thoughts are to wait until I reach .1. By then, if my PSA continues to demonstrate a slow and steady rise rather than leveling off, I would feel a little more confident that the PSA increase is due, in fact, to a recurrence and is not from benign prostate tissue.

RCS,

I asked my Uro about this several months back.  Although both nerves were spared during my surgery, he does not feel any prostate tissue was left behind.

Perhaps it's just wishful thinking on my own part, hoping that I don't really need SRT.  At least not yet.

I agree with purgatory. I have stopped sounding my drum spouting dis or dat ,on SRT over treatment. We are all driven differently. Your cancer isn't going to kill you with SRT or without SRT, in my opinion and I suspect in your doctors. caveat emptor. Good luck with your decision, sincerely…...