I'm not a doctor and my advice isn't worth much, but I agree
with your doctors and with Steve.

_IF_ cancer is still present, and waiting for one more PSA test to
confirm it might well be justified, then radiating it as early as possible
would seem to provide the very best chance of a cure.

If you were 25 years older than you are you might wonder if the
cancer is going to grow fast enough to kill you.  But at your age
it seems more than possible that it will reach a life threatening
stage before you die of some other old age disease.  So treatment
would indeed seem warranted.

There have been studies, I don't remember a citation but you can
probably find them on Pubmed, that found that early salvage
radiation is more effective than later salvage radiation.

If the doctors really think you have a recurrence of the disease,
and it sounds like all three specialists think it's likely, then I think
you'd want to get the treatment.

There are a number of people in this newsgroup who have had
both RP and radiation.  I don't recall any of them saying that
the side effects of radiation were significantly worse for them
than they were for other radiation patients.

There will likely be side effects.  In my case (I just had radiation,
no surgery) the main one was difficulty urinating for about five
months.  There were also smaller ones.  It was very bearable.

Good luck.

   Alan

Standard disclaimer here - I'm not a doctor or an expert in any way.

As I recall Bill, you are a guy who has had considerable success with
diet and lifestyle changes.  And you are not the only person on this
newsgroup who has.

There is always some risk with any invasive treatment.  Radiation is
invasive.  There is a risk of radiating something that shouldn't be
radiated and there is a small but apparently measurable increased
risk of developing other cancers some time in the future after
radiation.

So there is a lot of credibility to your position on this.

But, having said all that, I think I'd still be inclined towards getting
the radiation - IF AND ONLY IF the doctors are sure that there
really is a recurrence and that the slight PSA bump Fred has seen
so far is not a fluke of measurement.

My reasoning is that Fred is now only 56 or 57 years old.  He's
potentially got 20 - 30 years of life left.  That's a long time for
prostate cancer to develop.  Presumably, whatever ability his
body has to resist the cancer now will decrease with age.

If all that is true, he's likely going to have enough PSA rise
eventually to want radiation.  Better to get it now.  If there is
no study to show that it's better at .1 than 1.0, that may only
be because the studies haven't been done, not because it
isn't so.

As to your question about seminal vesical involvement, that
seems to me an excellent question that should be put to the
doctors.  If they suspect it, then maybe my position on this
should be modified.

Well, that's my inexpert two cents.

   Alan

I also wonder whether his statement "early beats later" includes SEs or
just addresses only the mutation picture. Certainly SEs are less of an
issue with RT than with ADT, especially in the short term, but it does
have risks, which are greater if the pt already has symptoms which can
be exacerbated by RT. Heck, if we looked only at the benefits, we'd all
get RP/RT/ADT/chemo and start drinking our own urine the first time our
PSA hit 3.0.

I.P.

Hey, don't anyone hold me up as a success story yet - it may well be
that I am just marking time. Nevertheless, assuming as I do that I had
systemic disease all along (which means that I have had ZERO Tx for the
most dangerous part of my case), my PSA has risen slower than I feared
and that might have been expected. At 47 mos. post-RP w/ no adjuvant or
salvage Tx my last PSA was .67, only up .07 in the previous 6 mos. I
was quite happy about that. I have not practiced what I suggested to
Fred in that I have not eliminated red meat from my diet. I do eat much
better than I used to but I am by no means on any extreme diet and I
still don't get near the amount of fruits and vegetables that I should.
I have never been into desserts so I do have a low sugar intake. I
attribute my "success" to a strong immune system - I never get sick; I
literally cannot remember the last time I was sick. I would say that I
have not seen a doctor for anything other than my PCa or arthritis in
decades. Of course, that is why I was diagnosed  w/ a first-ever PSA of
33! As all 3 men in my generation on my father's side have had PCa, my
otherwise undefeated immune system was faced w/ an even greater force -
genetics - and could not eradicate it on its own. At that time I took a
multi-vitamin but nothing else. I think that removing the vast majority
of the tumor load via RP has brought the disease down to a level that
my immune system now has a fighting chance. It may bend - my PSA will
surely continue to rise - but as long as it doesn't break for another
10 years or so, I will be happy. By then perhaps they will have
something else to take me to the end of my normal lifetime.

So, all I am saying to Fred, or anyone else in his position (low risk
disease, caught early, healthy person, recurrence caught really early
via ultrasensitive PSA) is that you do not have to rush into anything -
you have time, maybe even a year, before the optimum time for SRT
passes. You just might consider - w/ your doctor's oversight - dietary
change, an exercise regimen, and nutritional supplementation in the
meantime until your numbers tell you that is not working.

"This seems to be as good a point as any other to remind folks that
radiation therapy, specifically IMRT, is not necessarily confined only
to the gland (or the "bed"). It can also be programmed to treat the
seminal vesicles and pelvic lymph nodes, too."

I'm not that up on RT as a primary Tx but I assume that is the case.
However, that does not address the true implication of seminal vesicle
involvement. The reason SVI is a negative predictor of a durable
response to SRT is not because there may be residual PCa in them
(actually, what's left of them, since they are removed in toto in the
standard RP) but because SV tissue has high metastatic potential. The
fact is that if you had PCa in your SVs at the time of your primary Tx,
there is a much greater risk that the PCa had already gotten loose in
your body.

Bill Denton
RP 2/12/02
PSA .67
Memphis

Ron,

Very interesting indeed.

My views on best practices for PCa treatment keep changing all
the time.  I had been leaning towards aggressive treatment for
a recurrence, but this article makes me lean back again.  Their
conclusion is that some men should have aggressive treatment
after a recurrence and some men should not.  The key is to
find out what your personal recurrence characteristics are before
you decide what to do.

Fred,

You might print the Hopkins newsletter article and show it to
your doctor to see if he has an opinion about it, or if it modifies
his opinion about what to do in your case.

   Alan

A new prostate book on the shelves contains two interesting statements
about the differences between initial/primary RT and post-RP SRT,
paraphrased here:

1. SRT is far more likely to cause physical urinary complications such
as bladder neck constrictions, strictures, or [there was a third example
I've forgotten]. SRT ues higher power and thus cooks the goodies more
than primary RT, heightening their risk.

2. Because the cancer is now (presumed to be) outside the area the
prostate occupied, the SRT radiation field must sweep a wider area,
further heightening the risk to surrounding areas [such as the colon].

It was "The Complete Prostate Book" by J. Stephen Jones, published Sep
05. It's at Amazon, Powell's, etc. I found it too close to midnight and
too many hours from home last night to make careful notes or scan the
book thoroughly, but it looked like an excellent addition to our list of
recommended books.

I.P.

Whatever for?

Regards,

Steve J

"A man's most valuable trait is a judicious sense of what not to believe."
-- Euripides