Prostatectomy III | Salvage Therapy

Radiation Treatments

We are now halfway through the 25 radiation treatments I have to undergo.

What we never really considered or expected before the surgery was the fact that the cancer wouldn’t be gone. Incontinence, erections, and libido were the terms that came up, but never radiation treatments…

Here are some practical and technical aspects.

My PSA after the bilateral nerve-sparing prostatectomy in August 2024 was not zero, thus measurable.

A PSMA-PET/CT and pelvic MRI in March 2025 showed, as expected, no visible metastases. Based on the guidelines, a salvage course was decided: targeted radiation of the prostate bed + elective pelvic lymph nodes, combined with short androgen deprivation therapy (ADT) = hormone therapy.

Radiation Plan

In my case, the radiotherapy team proposed two target volumes:

• Prostate bed (high risk)
• Pelvic lymph nodes (elective area)

Schedule

• 62.5 Gy in 25 sessions (2.5 Gy) on the bed.

• 50 Gy in 25 sessions on the nodes (simultaneously integrated).

Every morning as preparation: bladder full, bowels empty.

Just before the radiation, a Cone Beam CT (CBCT) makes a control scan; this allows the table position to be adjusted to the millimeter.

Expected side effects of the treatment are urinary complaints (nocturia, pollakiuria, urgency, dysuria), more frequent bowel movements, and fatigue.

The machine: Varian TrueBeam STx

The scanner rotates once or twice to make control images. Then you are irradiated in two arc movements (± 90 s). This way, healthy tissue is maximally spared.

Here is a video about this process and the scanner

Androgen Deprivation Therapy (ADT) = hormone therapy

Most common side effects are hot flashes, erectile dysfunction and loss of libido, emotional instability, metabolic syndrome, and
weight gain.

Because due to the hormone therapy (ADT), the PSA drops almost immediately below the detection limit. This is because the remaining tumor cells go into a “dormant state”; a real evaluation can only be done when my testosterone has recovered.

Here is a snippet from my conversation with the uro-oncologist/radiotherapy specialist:

“A PSA of zero or non-measurable usually means there are no active prostate cells producing PSA. For example, after the prostate is removed, you should actually have no PSA in the blood. If PSA is still found, it may indicate remaining tumor cells or metastases.

A non-measurable PSA can also be the effect of radiation and hormonal therapy suppressing PSA.
That hormonal therapy ensures that the cancer cells do not grow, but they do not completely disappear.
They go into a kind of dormant state. If you only do hormonal therapy, the PSA decreases, but as soon as you stop, it can rise again.
So the radiation tries to kill the cells, and the hormonal therapy helps to cut off the escape routes of the malignant cells. By combining these, you limit the survival chances of the cancer cells as much as possible.”