Month 85–Learning about Salvage Radiation Therapy

Now that I’m officially halfway to the widely accepted 0.2 ng/ml definition of biochemical recurrence, it’s time to dig deeper into the most likely next step for me: Salvage Radiation Therapy (SRT).

I’ve already done considerable research on reputable websites and through reading studies or books, but the one area that I would like more information about is from those who have actually gone through SRT after a prostatectomy. Having those first-hand insights can be invaluable.

If you have had a radical prostatectomy and subsequent salvage radiation therapy because your PSA was on the rise just as mine is, please take a few minutes to answer my questions about your experience in my:

Salvage Radiation Therapy Questionnaire

It’s only 9 questions long and should take just a few minutes to complete. I’ll be truly grateful for your input.

If I’m being perfectly honest, I have real reservations and concerns about starting SRT. Like most everything else in dealing with prostate cancer, it seems to be yet another crap shoot with questionable outcomes at potentially significant cost to quality of life.

Based on my research, SRT doesn’t seem to have all that high of a success rate, with 30%–50% of patients being progression-free at 5 or 6 years after receiving SRT. That means that 50%–70% of the patients have the cancer remain and, as an added bonus, those patients now have increased incontinence and erectile dysfunction issues, as well as potential bowel control issues.

Before we start zapping my body with radiation, I want to know with a high degree of certainty that we’re zapping the actual location of the cancer. That poses two problems.

First, studies show that the earlier you start SRT, the higher the success rate. In fact, I would not be surprised to find a few survey respondents who have started SRT at a PSA level lower than my 0.10 ng/ml. The assumption is that any remaining cancer will be in the prostate bed or pelvic region, and that’s where they focus the radiation. But how do you know that it hasn’t spread beyond the pelvis at those PSA levels? You don’t. (That 30%-50% success rate tells me it isn’t the best assumption to be making.)

That brings us to the second problem. Current imaging techniques won’t locate the cancer until the PSA is at much higher levels. Even a choline-PET scan won’t consistently detect tumors until PSA reaches 2.0 ng/ml (it may be able to detect down to 1.0 ng/ml, but the number of false readings goes up considerably).

Do I risk all those nasty life-long side effects on the assumption that the cancer is still in the prostate bed, or do I wait until imaging technology can accurately detect the cancer’s location?

I’ll have a thorough discussion with my doctor next week when we review my latest PSA results, so it will be interesting to get that input. I’ll keep you posted.

Thanks again if you’ve taken time to complete my questionnaire.

5 thoughts on “Month 85–Learning about Salvage Radiation Therapy

  1. Ken

    Dan, yup, studies have shown that for men with adverse pathology (if I recall, that’s not you), a reading of .03 is pretty much predictive of BCR. And today’s scans have a tough time locating the cancer. The choline scan is old news, the f18 Auximin scan is better (I think that’s what it’s called) but not sure it would pick up anything at .1
    I don’t have the answer. I’m right behind you, with my last 4 readings after 2 years of


  2. Patrick McGough

    Glad to have taken your survey since I have very relevant experience. I had a lot of “other comments” to offer and got a little carried away and I hope it saved it all. Sorry to be kind of long-winded. I’ll leave my info below, in case my comments got truncated. All the best on your journey, so glad to have found your blog.


  3. Charles

    Hi Dan,
    I share your concerns about general treatments that are done without knowing definitively where the cancer or cancers are located. It reeks of a “Ready! Fire! Aim!” approach which does work for a proportion of patients but not for another proportion of patients.
    I have been reading about 68 Ga (Gallium) PSMA (Prostate Specific Membrane Antigen) PET (Positron Emission Tomography) /CT (Computerised Tomography) which it is claimed “may identify smaller tumours than standard methods. However, I believe this may be still experimental and don’t know how widely available it is.


    1. Hi Charles. Thanks for your comments. I actually came across a study about PSMA this week, and I think it’s the same one as what you’re referring to. It looks promising.


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