Is it time for salvage radiation?

Unfortunately it looks like it might be time for salvage radiation.

A brief history, DX  December of 2012 with a PSA of 9, I had De Vinci RP 3-12-13 at University of Chicago,  my tumor was 10% of the prostate, Gleason 3+4, with 1 positive margin. My first PSA at 6 weeks post-op was .347 tested at local lab.  At 3 months it was .39, tested at the U. of C., my surgeon ordered a bone scan at that time and fortunately it came back negative.  My surgeon had me follow up with a hematology oncologist at U. of C. who recommended an MRI to look for anything in the prostate bed and then see a Radiation Oncologist for salvage radiation. When I saw the hematology oncologist he ran another PSA, only 2 weeks after the 3 month test and it came back .69, I can hardly believe the jump in 2 weeks. Before I got the last PSA results I was planning on waiting until my 6 month follow up to decide on any further treatment but now I’m thinking SRT is the way to go. What do you guys think?

Thanks, Bill

Bill - looks like you might be on your way to SRT. It's the doubling time that is worrying.

Worse things can happen and no ones to endure that but it's something you can get through.

I am right in assuming that your docs are recommending SRT now? If so, I'd go with it. Are the thinking of combining SRT with any HT? If you're going aggressive you might want to do both but I'd bet you'd be fine getting a little zap and they checking things out.

Hang in there,
Andrew

Bill,
I also agree it is time to see a Radiation Oncologist. You are past the threshold of 0.4, which I took as the go-ahead for my own SRT. And you are also having accelerating PSA very soon after your RP. Based on what I read three years ago, before my SRT, you want to have SRT somewhere between 0.4 and 2.0 -- the closer to the lower end the better.

You should also ask your RO and Uro if they recommend hormone therapy along with SRT. In my case I was on Casodex for a few months during and after SRT. I know from reading this site that many others who had more aggressive signs than mine were on Lupron in addition to their SRT. Please keep checking in here to keep us posted and to advise others whose situation may be similar to your own. Best wishes.

Jim

The PSA threshold for recurrence as used by both AUA and ASTRO is: "clinicians should define biochemical recurrence as a detectable or rising PSA value after surgery that is ≥ 0.2 ng/ml with a second confirmatory level ≥ 0.2 ng/ml."

ASTRO and AUA issue joint guideline for radiation therapy after prostatectomy - May 2013

You should have been put on ADT and seen an RO already. Dr. King has found that for every +.1 increase in PSA over the .2 threshold, there is a 2.6% loss in relapse-free survival (which is 64% at a PSA of .2). So men with a PSA at .7 after RP have about a 51% chance of relapse-free survival if they get 70 Gy of radiation. Don't put this off.

The timing of salvage radiotherapy after radical prostatectomy

- Allen

I agree with what others have said. I just got my first PSA after SRT and it came down from .22 to .04 with no side effects, so don't be overly worried about radiation. If you choose SRT I strongly recommend going to a center where they use IGRT, that's where they do a CT scan before every treatment. And be sure to have your bladder full before each and e every treatment to minimize SEs.

You have some good factors on your side. The positive margin is a good indication that the psa is coming from local cells and the radiation can kill them. And a fast doubling time is also good because you want those little suckers to be dividing when they're being radiated.

Good luck!