DjinTonic said...
Thanks, Jack. Ah, if it all were so easy! 
But as we know, life comes with catches. Not all men with BCR (a post-RP rise in PSA past 0.2) go on to clinical recurrence of the disease (demonstrable lesions).
For those who want to attempt preventive therapy, there is the question of timing. For men who had a higher-risk staging after surgery, studies seem to show a statistical advantage in outcomes if salvage treatment is started even before the official BCR poin of 0.2. Just how much before isn't clear. And the earlier you start, the greater the chances of overtreatment, since you may not be giving your PSA the maximum chance to plateau. Another issue is the treatment choice, e.g. SRT or SRT + ADT. Then there is the question of the size of irradiation field to the pelvis if nothing is revealed on imaging (prostate bed, wider, or even whole-pelvis?). And the question of what RT dosage to use (higher dosage increases the changes of GI toxicities.)
I could be proven wrong, but it appears that educated guesswork is involved, with the "educated" part hopefully increasing and the guesswork decreasing as time goes by. A rule of thumb (e.g. "the higher your risk category, the lower the PSA at which you want to start salvage therapy") gets you only part of the way; you don't want to be "all thumbs."
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Wow, Djin! I have been following you post/story and I was amazed to see(just noticed) that you began your for sure rise(i.e. definitely leaving any plateau) right about
the same time as I did. Now, not really the same, since my PSA had been
slowly but steadily rising for quite some time. But in my case, mine started taking off just about
the same time as yours, more or less. Just a steeper climb.
I had been getting my normal CT and bone scans done locally, which always showed nothing. Then they started sending me 90 minutes away(to Memphis) for Auxumin scans, which still showed nothing, even with a PSA of 2 or 3+(if memory serves). They had been wanting to radiate, but I was:
1: hoping for spot radiation, and for that the RO needed to see something on a scan and
2: I kept asking several docs "how do you know where to radiate?" And the answer was, from each doc, "we don't, but the odds are 3 out of 4 it is in the prostate bed, so we will radiate there".
Then my PSA
jumped to 6, and they wanted to run another bone/CT scan just a very few months after the last negative auxumin scan. I thought "Really? What is this going to show that the auxumin would not". But sure enough, wide spread mets! Distant bone and lymph nodes! They told me "no spot or any other radiation for you, there is just too much.". And "
Oh, BTW, one place it is not is the prostate bed!"........... Where they wanted to radiate! So anyway, they called last week and want me to have my first ever PSMA next week. I don't understand why, because they have only been offering me once a year bone/CT scans unless my PSA started rising, and those scans are not due until January of 25. But, my PSA, ckecked every 3 months for almost 3 years, which went undetectable 30 days ( <.05 ) after they started me on ADT (Orgovix and Erleada) 2.75 years ago, still has not risen, still have my "<" sign. So, I don't know why they are suddenly offering me a PSMA scan, but I will take it. Makes me nervous though.
Good luck to you as you figure out exactly how to proceed!
Bill