Salvage RT at very low PSA value

Hi
I had a RP 3 years ago, Gleason 3+4 .My PSA remained undetectable for two years then it started toi rise very gradually.
It is now 0.07 and my urologist referred me to an oncologist who is now recommending me to have salvage RT together with 24 months ADT.
I was puzzled by this recommendation and I have read ALL of the research.
None of it relates to men with very low PSA values!
Is anyone aware of any hard evidence that it is better to have SRT with a PSA below 0.1 rather than say 0.5?
As to the ADT recommendation, I now realise that this depends on some very debatebable ‘research’.
Other people’s experience and opinions would be welcomed.

Before my SRT I met with two radiation oncologists, and nether recommended ADT. I was less than a year out from surgery, and I also had very low but rising PSA. I'd ask the RO why he or she is recommending ADT.

See this thread on 2015 UCLA study suggesting the threshold for BCR should be 0.03:
/www.healingwell.com/community/default.aspx?f=35&m=3396059

Traderboy said...
Thank you Fiddlecanoe for your interesting comment.
I had no SVI and minor focal PSM. Otherwise I have no high risk characteristics.
Can I ask why you decided to have IMRT with your PSA at such low value?

If I may answer for Fiddlecanoe, SVI is an adverse pathology which indicates locally advanced PCa that traditionally calls for adjuvant radiation post-op. I think the figure is something like 50/50 regarding likelihood of BCR (though I may be wrong on that). In his case the PSM is an additional factor. In these cases it is generally recommended to proceed with ART as soon as continence is regained, regardless of PSA.

I don't see it in his sig but I'm guessing he is T3bR1.

Regarding the ADT, my RO informed me that there were two studies that demonstrated improved outcome from RT with neoadjuvant HT added. One study was six months of HT and the other was two years. BTW the Uro who did my RP recommended three years of HT, but I compromised with my RO in light of studies suggesting that 18 months is equally effective as two or even three years.

Trader, here is a study you might be interested in, it was used by an RO at Cleveland Clinic Florida, at our meeting, to support his recommendation to treat now, which in my case, is .06. I too am 3+ years out of RALP, and was also undetectable until 2 years....

/jamanetwork.com/journals/jamaoncology/article-abstract/2670381

“Conclusions and Relevance Adjuvant RT, compared with ESRT, was associated with reduced biochemical recurrence, distant metastases, and death for high-risk patients, pending prospective validation. These findings suggest that a greater proportion of patients with prostate cancer who have adverse pathological features may benefit from postprostatectomy ART rather than surveillance followed by ESRT.

In this case, ART means RT at PSA levels below .1, while eSRT is RT with PSA levels between .1 and .5.

The same Cleveland Clinic RO told me that he would NOT recommend ADT with a Gleason score of g7(3+4).

I see an RO at MSKCC mid June and will report back. Or feel free to email me, we are rowing the same wayward boat. As in “up the creek without a paddle” with no black and white answers.

Pratoman said...
The same Cleveland Clinic RO told me that he would NOT recommend ADT with a Gleason score of g7(3+4).

Prato, that's one club we can all be glad you won't be joining!

RobLee said...

Pratoman said...
The same Cleveland Clinic RO told me that he would NOT recommend ADT with a Gleason score of g7(3+4).

Prato, that's one club we can all be glad you won't be joining!

Rob, I hope so, I still need to hear that from the NY RO at MSKCC which is where I’ll hve treatment. If he says do ADT, then I’ve got a dilemma.