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Starting Salvage RT earlier than I expected.

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User
Posted 31 Mar 2023 at 00:17
With positive margins and that PSA pattern, you seem to be a classic case for recurrence in the prostate bed. If the PSMA doesn't spot anything, I think I would take a punt on the salvage RT. John had salvage RT 11 years ago and it mostly seems like a distant memory now.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 31 Mar 2023 at 08:37

Thanks Lyn - indeed. Thats the plan, just coming to terms with it. 

User
Posted 02 Apr 2023 at 12:09

Hi Staggered. 

I had surgery in June 2020. Positive margins and PSA of 0.2 rising to 0.5 after 3 months. T3a.

Started HT (Prostap 3) and RT in Dec. Didn't mind the RT at all. A bit of a faf with hydrating before but treatment itself easy.

I found the HT quite hard with loads of flushes and big loss of strength and energy. Last HT injection in April 22, so in my system fully until July. 

My testosterone has started coming back over the last couple of months and my energy has increased tremendously.  👍

Good luck on your journey.

Jim

 

 

User
Posted 05 Apr 2023 at 14:18

Short update - PSA now at 0.2, thats doubled (or jumped 0.1, depending on how you look at it) in just four weeks. There was me thinking we were ahead of the game having ‘the chat’ at 0.1 …

ONC saying they don’t see any benefit in pursuing a private PSMA PET scan, but with current 6-10wk wait I’m very concerned at growth in the meantime.

They don’t see next treatment step as urgent; they suspect radiotherapy but need to await scan to ensure this is correct way forward (obviously); and are “hopeful that unless the scan shows cancer away from the prostate bed that we are still hoping to cure you”.

Any thoughts? All seems a bit too relaxed to me, but then I’m on this side.

User
Posted 05 Apr 2023 at 23:29
With that positive margin you know where you have some cancer left. I think you are right to be concerned about your oncos ambivalence.

You really have 2 choices press for salvage RT now OR wait until you can get a scan anticipating it may change the RT targets.

User
Posted 05 Apr 2023 at 23:39

Am actively pursuing a private scan, assuming that should be available on a more reasonable timeline. Sod the cost. 

User
Posted 05 Apr 2023 at 23:55

Chippers, my private onco requested a PSMA scan on 31/3/23, my scan is booked for 24/04/23. I have got to travel just over 100 miles.

Thanks Chris 

User
Posted 05 Apr 2023 at 23:59

Perhaps the scholars would have a look at the above article that popped up today on practice update. It relates to when salvage RT should be carried out. It is research that was done between 1990 and 2020.

https://ascopubs.org/doi/full/10.1200/JCO.22.02489

Thanks Chris

 

Edited by moderator 06 Jul 2023 at 14:14  | Reason: Not specified

User
Posted 06 Apr 2023 at 15:05

Thanks Chris, I did a huge amount of reading on these factors before I had SRT. All studies seem to point towards early initiation of SRT and with PSA below 0.2 or 0.25 being significant in terms of all cause mortality and prostate cancer mortality.
Thus study confirms this. It also states that the actual delivery program of SRT is altered after PET and MRI scans show where any recurrence is. Whether being able to tailor the SRT according to scan information improves mortality is now to be studied, it will be interesting to see what that concludes.

Most studies also show that higher risk recurrences benefit more than lower level recurrences from aggressive salvage treatment including ADT. 

In my case my PSA very quickly reached 0.8 before HT was administered bringing it down to 0.1. I still am concerned my PSA was relatively high before commencement of SRT. But happily my PSA remains <0.1. 

Ido4

User
Posted 06 Apr 2023 at 15:48

Originally Posted by: Online Community Member

Short update - PSA now at 0.2, thats doubled (or jumped 0.1, depending on how you look at it) in just four weeks. There was me thinking we were ahead of the game having ‘the chat’ at 0.1 …

ONC saying they don’t see any benefit in pursuing a private PSMA PET scan, but with current 6-10wk wait I’m very concerned at growth in the meantime.

They don’t see next treatment step as urgent; they suspect radiotherapy but need to await scan to ensure this is correct way forward (obviously); and are “hopeful that unless the scan shows cancer away from the prostate bed that we are still hoping to cure you”.

Any thoughts? All seems a bit too relaxed to me, but then I’m on this side.

So sorry to read this Chippers. Wishing you all the best brother.

Jamie

User
Posted 06 Apr 2023 at 16:39

Chippers, given the results of the study Chris highlighted earlier and your rising PSA . Salvage radiotherapy sooner rather than later seems sensible. 

Ido4

User
Posted 17 Apr 2023 at 14:04

Just had a call for private PSMA-PET scan (need to drive Cheshire to Oxford), £2500, 10th May ... after referral around 5th April. Have been told NHS (in Cheshire certainly) is a 2-3 month wait, and privately at The Christie is no faster.

Just keen now to know how significant this recurrence is... every day passing seem like weeks.

 
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