When should the patient and doctor consider salvage radiation therapy?

I agree with you that you ought to have a conversation with an RO then. Dr Gross is a great MO, imho, but he's not a specialist in what you need right now.

Certainly, a lot of psychic effects.

In Houston, you have MD Anderson and Baylor to choose from. I'm sure there are lots of great ROs to choose from. Maybe others can recommend one by name.

- Allen

HI Allen,

I made that appt and met with him the other week. I did mention your name.
To summarize he felt, or rather seemed pretty certain that my cancer was confined to the prostate bed, 70% chance of cure using radiation to that area 8wks. I asked about hormone therapy in conjuction but he said no that if it was spread to lymph nodes maybe but in my case the scans (done over a year ago) indicated no involvement there. on that and my psas he based his conclusion.
I would like to believe him of course. My psa as mentioned earlier I think is .32 and the doubling time I see as around 4 months. are there any new scans or means of isolating where the cancer might be hiding?

Dr. King does a lot of salvage radiation, so he would know, and he's not the kind of doctor who tells a patient what he wants to hear. He's a leading researcher and is very evidence-based in his judgments. He keeps me honest.

I certainly understand your frustration. Unfortunately, your PSA is too low for any known kind of PET imaging to detect it it, although your PSADT may indicate something big enough to be detectable.There is one clinical trial in St. Louis of a new kind of PET/MRI rather than a PET/CT that might find something that small, but I wouldn't bet on it, and I don't know what the cost is. They only require a PSA>0.2 after surgery to qualify. They use the C-11 Choline indicator with the new machine. You can call them:

/clinicaltrials.gov/ct2/show/NCT02355054

There are a few clinical trials of PET scans using PSMA antibodies, like the one wampuscats and Sonny got, but I think your PSA may be too low for those.

- Allen

(I copied this from what I posted on your other thread, which you should probably delete.)

It seems really clear to me. If you want to learn about surgery, see a surgeon. If you want to learn about medical treatments for advanced disease, see a medical oncologist. If you want to learn about curative or palliative radiation therapists, see a radiation oncologist. In our age of specialization, you have to see a specialist. It would be unreasonable to assume that, say, a medical oncologist knows diddlysquat about radiation oncology, etc. Why would you even ask?

In your case, you are wondering if salvage radiation can cure you. You were told by an eminent radiation oncologist that based on your numbers, you have a 70% chance of cure. He would know - he does it for a living. The others would not know - they don't do radiation oncology. The only danger is if a doctor inflates the odds, but, knowing your doctor, he is the least likely person to do that. He tends to be overly conservative in his estimates, as I think he will admit.

One of the problems with forums like these is that we see others going to see different doctors for different situations, and we may not immediately distinguish whether their case is really applicable to our case. Sometimes lots of us mention doctor's names, and sometimes they publicize themselves really well, creating a "jump on the bandwagon" kind of fervor. It may sound good to have a "team of doctors," but that is seldom how it works in the real world, and may cause more problems than it creates - conflicting protocols do no one a service.

I think the last thing you need is a consult with Dr. Myers at this point. The first decision rests with you, and what you decide will then dictate what kind of doctor you need. Here's the question -- do you want to go for the cure (with whatever risks and SEs that entails), or do you want to manage the disease for the rest of your life (with whatever risks and SEs that entails)? If you want to go for a cure, you have to see an RO. If you want to manage the disease, you'll want to see an MO (e.g., Gross, Myers, Scholz). No doctor can decide this for you - you have to decide. If there is more info you need to make that decision, you have to identify what that information is.

- Allen

David-
It's often hard to discern what we have control over at a given point in time, and what's in God's hands. It sounds like you've sorted that out, and you're making a carefully considered decision, if a difficult one. It doesn't get much better than MD Anderson, so you are in good hands there. I love that you're at peace with it, and really have no advice -- you're doing fine.
- Allen

I understand what you are saying Allen and I am still looking for that information to make that decision. Dr king did not say the cure was certain..he said there was a 30% chance of failure. I am looking for 20% or below if it exists if not I most likely would radiate as its the best chance out there. I have not established that for sure, I have several months yet to decide which by the way both my MO and the RO agree on. Dr Gross has been very helpful and encouraging of my exploring ways to treat this problem everything from radiation/hormones to nutrition to clinical trials. He also says he is willing to collaborate with whoever I decide on if they wish.

Startech, were of the same mind re cure and management. Best of luck!

Cheers, Doug

I got my Feb 5 result back and it's up again, now to .181. I'm seeing Myers in a month but after reading all this and Tall Allen's other posts on how bad radiation is, then how low risk of secondary cancer radiation is, I'm getting pretty nervous. My path report showed one spot with surgical margin only 0.1mm, but otherwise ok. Should I get that re-read to help target eventual radiation treatment? In another Tall Allen post it seems I should be looking for a SABR expert. Does anyone have a recommendation in NW suburbs of Chicago? I'm pretty much continent now - sneezing is still an occasional issue. I can put up with that if radiation can put me into remission. I'm getting close to retirement, maybe a year or less. Maybe I should just bite that bullet so I can travel wherever the best place is. Catalona wouldn't have sent me for radiation yet either, so after seeing two of the top docs in the country I'm still not on the path to cure I thought surgery was. I'm very down and frustrated.

I see that now Rigby, deleted the post. I still think though that it's small and local. The problem remains the treatment. Have you thought about HT to keep the PSA in check if you'd rather not have radiation?

Cheers, Doug

I saw this today and dug it out of the computer trash. Could this be a help in someone's decision making?

http://www.medicalnewstoday.com/releases/289114.php?tw

Jane B.