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Adjuvant Radiation

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Posted 2/4/2017 9:06 AM (GMT -5)
My PSA has gone up to 0.132 and now the doc is talking about Adjuvant Radiation........Any imput.....He said he is not talking about Salvage Radiation. Both scan and MRI came back negative.

My doctor says that my path report showed no cancer outside the Prostate, so he thinks their could be a micro pc flooding around in my body at this time, and radiation might do nothing because it isn't in my prostate area.

Should I wait until .5 or so and then get Lupron? My wife is really concerned about the side effects of the radiation treatments. Even though everyone says that side effects are rare during the treatments, my doctor says that side effects can occur three plus years after the treatments are over.

So hard to know what to do. We are meeting with a RO on the 10th, and my wife feels he will of course say go for the radiation.

Don't know what to do.
Posted 2/4/2017 11:08 AM (GMT -5)
I would vote for starting hormonal treatment sooner than later. There have been some studies showing better long term results starting while your PSA is still low. You may also want to discuss intermediate hormonal treatment. Lupron does have some side effects but for me they have been manageable.

For me The side effects of radiation have not been that bad. In your case I do not think that radiation is appropriate. Unless there is evidence that the cancer is in the pelvic area, I do not see the benefits of radiation.

Stay strong!
Posted 2/4/2017 11:15 AM (GMT -5)
There is still a good chance for a cure, or at least further delaying the recurrence. Why not take it? The radiation treatments are easy once you get into the routine. Chances of SE's are possible but I've had none, one year out. Your doc might be correct, it might be out already. But nobody knows for sure. Nothings guaranteed, except HT if you do nothing.
Posted 2/4/2017 11:51 AM (GMT -5)

Steve0 said...
My PSA has gone up to 0.132 and now the doc is talking about Adjuvant Radiation........Any input.....He said he is not talking about Salvage Radiation.

Sorry you are faced with this rock and a hard place bigger than the initial treatment decision. I went for the HT/Radiation because there is still that chance of a cure. Again a tough call but one you will have to make and fairly soon. The longer you wait, the higher your PSA will be and the less likely the radiation will do any good.

Not sure about what I quoted. I could be wrong but I thought the only difference between Adjuvant and Salvage radiation is the timing. With Adjuvant it's given as soon as possible after surgery even if your PSA is still undetectable. (typically done for the higher risk cases) Salvage is given after your PSA begins to rise post surgery which appears to be the case for you.

The radiation treatment itself is the same, just the timing and reason to start it differ. Again, I'm not a doc so could easily be wrong.
Posted 2/4/2017 1:16 PM (GMT -5)
Radiation is no longer a shot-gun type beam but rather a very precise beam that limits hitting your organs directly. They would carefully position me on the table and then scan me to get the organ positions for that day so they could adjust the beam direction. The overall accuracy could be felt in the table adjustments they would make right before starting. From the control room they would move me around by literally a few hairs to get things lined up - this greatly increased my confidence. Walking or anything to get your blood moving is also key..... There are no perfect solutions to the many possibilities.. good luck!
Posted 2/4/2017 1:28 PM (GMT -5)
They often call it "early salvage." It doesn't really matter what you call it - it's the same treatment. Get your info about it from an RO (someone who has actually done the treatment and followed such patients) rather than a Uro. Sooner is better than later. The RO will probably recommend at least some adjuvant ADT with it, beginning 2 months prior to the radiation.

There is always the possibility that the PC is already systemic and micrometastatic. Yet for men like you who had no adverse pathology, the odds of salvage radiation successfully curing you are pretty good. You've had plenty of time to heal from your surgery, so you may be lucky with SEs.

Here's a nomogram that shows you your odds that salvage radiation will be successful. As far as I can tell, if you are treated soon, your probability of a cure is over 70%:

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html
Posted 2/4/2017 3:33 PM (GMT -5)
Adjuvant radiation (ART) is without waiting to see what PSA is going to be. Salvage (SRT) is when you wait for PSA to rise. Since Steve had surgery 2014 it is salvage for him.
Once a PSA relapse has been diagnosed you want to know if recurrence has developed at local or distant sites, since SRT is futile if distant, but I think that SRT is usually decided without proof of local recurrence, especially when PSA is this low.
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