My urologist has told me, and the literature also seems to say, that
Pca recurrence is not "official" until PSA hits 0.2. PSA doubling time
is also an important parameter. My PSA was 0.03 three months after RRP,
0.07 nine months after, and 0.08 one year later. Again, according to my
urologist, the leveling off may indicate a sliver of normal prostate
left behind in which case the readings will stay at that approximate
level for a number of years. If it were me, I would not jump into
hormone therapy with a reading under 0.2.

It is probably too early to tell if the radiation was effective.  It is
frustrating, but he has to wait to see what happens with the PSA.

The fact that the PSA is not zero suggests that the prostate cancer has
recurred.   If it is still isolated in the local area, it is possible
the radiation can eliminate it.   If not, then the usual treatment is
hormone therapy.   There is some difference of opinion among experts in
treating prostate cancer whether to begin hormone therapy right away or
to wait until there are more explicit symptoms that the cancer has
spread.  Hormone therapy only controls the cancer and doesn't cure it,
and the amount of time it is effective can be quite variable, depending
on the individual.   The fact that it took five years for the PSA to
recur is a good sign and if it take longer than 10 months to double,
that is also a good sign.   Studies show that men who experience that
kind of recurrence tend to do quite well even if hormone therapy is
delayed until there are other symptoms.

It is natural to want to be able to cure it, but given the current state
of knowledge, that may not be possible.  In a few years it might be
because of new approaches to treating prostate cancer.   The important
thing is not to panic.  There is no immediate danger.   Your
father-in-law should discuss all this with his urologist and also get
opinions from other specialists including one or more oncologists who
specialize in the treatment of prostate cancer.

I don't know how old your father-in-law is, but many men in his
situation live out their normal lifespan and die with cancer rather than
of it.

A recent book which describes all this was written by Peter Scardino at
Sloan Kettering.   He is a world famous expert in prostate cancer, and I
found his book very readable.  I also found it at my public library.

(snip)

What is his age and general physical condition?

What was the Gleason score prior to surgery?

Was a PAP (prostatic acid phosphatase) blood test done?

Was a DNA ploidy test done on the biopsy specimens?

The above are three of the staging tests that can and should be (but often
are not) done to determine the aggressiveness of the cancer.

It appears that the patient MAY be experiencing a PSA recurrence and PCa
progression, which I understand can happen in about thirty percent of RP
patients. However, it would be prudent to do enough PSA tests to establish
whether and how fast the PSA actually is changing. Maybe, to comply with
the standard set by the American Society of Clinical Oncology, three tests
should be performed. Per ASCO, three successive rises in PSA is evidence of
PSA recurrence, which in turn means that the PCa has probably come back
(or, rather, never left).

The doctor suggested localized radiation therapy, which my

Very possibly. As I wrote above, it might be evidence that it never left.

The series of PSA tests recommended by the medic is consistent with ASCO's
standards.

BTW, is the medic a uro or an oncologist? Judging from what Dom wrote, it
would seem that a uro has done all that he's able, and it's time to consult
an oncologist.

It may well be that the PCa is systemic, which, though it's serious enough,
is *not* the same as metastatic. If this is the case, the PCa is incurable
with the present medical science.

However, much can be done. Regarding the radiation therapy, I'm surprised
that it was not done with adjuvant ADT (androgen deprivation therapy, the
proper name for hormone therapy).

ADT may well be the best next step. There are studies being done that
combine ADT with a chemotherapy agent such as Taxotere. I understand that
the results give cause for optimism, but AIUI the tx is not yet approved by
the FDA.

If the medic is confident that three months to make sure that the situation
is properly understood, I would have to agree (for whatever that's worth)
that that is the prudent course. Some other tests can be helpful,
especially the PAP.

For authoritative information, I suggest the following:

1. The website of the Prostate Cancer Research Institute at
http://prostate-cancer.org/index.html

2. Invest in and study _A Primer on Prostate Cancer_, subtitled "The
Empowered Patient's Guide" by oncologist and PCa specialist Stephen B.
Strum, MD and PCa warrior Donna Pogliano. IMO, it is this book more than
anything else that has enabled me to (so far) survive two very aggressive
PCa tumors.

3. Go to http://www.prostatepointers.org/p2p/ and post questions after
preparing the required Prostate Cancer Digest. Some of the most eminent PCa
specialists on the planet post responses, and it costs not a farthing. I
know that at least one of them charges private patients $600 per hour.

Good luck, and please keep us informed.

Regards,

Steve J

"Never give in--never, never, never, never, in nothing great or small,
large or petty, never give in except to convictions of honour and good
sense. Never yield to force; never yield to the apparently overwhelming
might of the enemy.''
--Sir Winston L. S. Churchill

There isn't much that I can add to the excellent replies you've
already gotten, but I'll reiterate what others have said - that
odds are good that this is not yet, and maybe not ever, a life
threatening situation.

Hormone therapy has undesirable side effects.  You only want
it if you really need it.  It destroys libido and damages
sex life.  It can cause arthritic like problems in people who
are prone to that.  It can reduce one's energy.  Some people
report that they are not as mentally sharp as they were before
taking HT - though many others do not report that problem.  It
can prolong life and cure symptoms, but it does so at a cost.

Assuming your FIL has cancer (which looks very possible but not
at all certain), he's taken 5 years to get to .12 and some more
time to get .02 higher.  I don't know how old he is, but it's
conceivable that the cancer is growing so slowly that it will
never need to be treated.

There are a number of very promising new treatments in clinical
trials right now.  If some of them pan out, they are very likely
to be available by the time your FIL could benefit from them.

My advice to your father-in-law is to move very deliberately
and conservatively and not jump into more treatment and more
side effects.  First be sure that the radiation really has
failed to arrest the progress of the cancer.  Radiation does
not kill cancer all at once.  It damages the tumor cells and
may actually cause them to produce extra PSA as they are
dying.

If and when it does become clear that the cancer is back, then
it's a good idea to get an opinion from a medical oncologist
specializing in prostate cancer.  It never hurts to get two
opinions.  Study the options.  Study the treatments.  Then make
a decision.

I'm betting that you and your FIL are still going to enjoy
a good time together 10 years from now and, if he's young
enough, maybe 15 or 20 years too.

Our best wishes to him.

   Alan

There is a lot more to an accurate prognosis than what you have given.  His
age is very important.  His Stage (T1a, T2b... ) and Gleason scores might be
less important five years later, but certainly interesting.

However....

Generally speaking, if there is an absolute cure, his PSA should be < 0.1
for 15 years.  If it starts to go up, the next step is often radiation to
the prostate bed (where the prostate used to be).  After that, the hope is
that the PSA goes down slowly and then levels off for 15 years.

But, no one really knows anything about prostate cancer based on one PSA
test and that's all he's had following the treatment.  He will need at least
one more (three months later) and probably one after that to be sure.

So, the answers are, "yes, he may have a recurrence of cancer and, yes, he
will have to wait to find out."  Fortunately, prostate cancer grows
relatively slowly, so he'll be okay in the interim.