If you do adjuvant radiation can you still have salvage radiation later on?

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Regular Member

Date Joined Dec 2009
Total Posts : 316
   Posted 1/5/2010 8:52 AM (GMT -6)   
Hi guys I hope you all had a great new year.
My father is considering doing adjuvant radiation 2 months after his open RP. His path report showed a gleason 9, t3b, negative margins. His post op psa was 4.1. Which still boggles me, with such a low psa how can all this have been going on?
I really hope he still has a possibility of cure, although I know that it is very unlikely. I just had a question. A doctor told me that once you get adjuvant radiation you can't do salvage later on. Additionally, once you do lupron in combination with radiation you can't use it as a last resort later on as well. I read about Lupron, but about radiation nothing I read seems to point in that direction. Do you guys have any advice on this topic? Thanks.

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 1/5/2010 9:11 AM (GMT -6)   
Luv, sorry you and your dad are facing this.

Once the prostate is removed, there should be no measurable PSA left. Any PSA that is higher than 0.1 or 0.2 generally indicates that there are still prostate cancer cells somewhere in the body that are manufacturing the PSA. Your confusion over the PSA seems to stem from the fact that before surgery, a PSA of 4.1 would not necessarily ring any alarm bells. After surgery, however, it is an entirely different story and indicates that the cancer is still active somewhere. The key is figuring out where, and whether or not radiation would attack all of it.

In answer to your original question, radiation to a particular area of the body is done once. So, adjuvant radiation would rule out salvage therapy to the pelvic area.

What is your dad's doctor recommending at this point? Surely with a post-op PSA of 4.1 he or she has some opinion about next steps. Have any other tests been done - e.g., bone scan, MRI, etc.?

I'm sure that more folks will chime in soon so stay with us, please.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!

Regular Member

Date Joined Dec 2009
Total Posts : 316
   Posted 1/5/2010 10:13 AM (GMT -6)   
Sorry there was a mistake his PRE OP psa was 4.1 he still hasn't checked it after surgery yet. Sorry I know this makes a huge difference!
He has to wait another 6 weeks (his surgery was about two weeks ago) for a psa test. Hopefully it will be undetectable. I think now you can understand what my confusion is.

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 1/5/2010 10:18 AM (GMT -6)   

That's makes a huge difference in thinking, figured that is what you meant to say. There is a lot of PSA anixety, especially waiting for that first one post surgery. Even with his pre-surgery numbers, he still may do very well.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 1/5/2010 12:44 PM (GMT -6)   
There is no reason to have salvage radiation after having adjuvant radiation. If the adjuvant treatment didn't work it means the PC is outside of any type of local treatment. Hormone Therapy would be the next treatment step.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


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