Linda,

Well, the figures you want are on  pages 309 and 310 of Dr. Walsh's book,
but it's too much to type out.  Except that .1 does not qualify as "PSA
recurrence," so he's still in the clear.

So no, there is nothing more to do at the moment but work on that dribbling
with Kegel exercises, and on the erectile dysfunction in ways that some of
the other posters know more about than me.

If you don't get many comments here, remind us of his Gleason score and
whether or not he had a positive surgical margin.  With that information,
people can check the literature and give you a better answer.

jimhoney

I'm sorry to hear that the PSA test was not "undetectable" by the tests
as available in your community.   But it may be a bit early to assume
the cancer has recurred.

See what Walsh has to say on these matters in Guide to Surviving
Prostate Cancer.  He claims that it doesn't hurt to wait for followup
treatment, if it turns out to be necessary.   One possible followup is
radiation, which makes sense if the cancer has recurred locally.   If
the reuccrence is due to distant spread, radiation of the prostate bed,
won't cure it.  But here again, waiting, according to Walsh, doesn't
reduce the patient's chances.

It is probably a good idea for you to continue to educate yourself about
prostate cancer and to suggest possibilities to your husband and his
doctor.   But it is rather unlikely that another urologist would do
anything much different.

Hi Linda...In my opinion, it is too soon to say that your husband has
recurred.  There are many reasons besides recurrence that may have
produced the "apparent" PSA increase.  For example, has your husband
stopped any medications recently?  I have been reading (in another
newsgroup - PHML) of PSA decreases / increases associated with people
starting / stopping certain blood pressure medications.  In any case,
the uro is probably saying that he wants to see 0.4 before taking
action because this would permit 2 PSA doublings (0.1 to 0.2 and 0.2
to 0.4) to be observed.  This would be convincing evidence of
recurrence.  If doubling does occur, the time required to double is a
significant indicator of how aggressive the PCa is.

I think your case illustrates one of the advantages of using the
ultrasensitive PSA test (your doc or hospital can send blood samples
to a different lab to have this test performed).  Basically, had it
been run, you would now know whether the PSA had "moved" from 0.09 to
0.10 (perhaps normal random variation) or from .05 or less to 0.1 (an
upward trend).  Rather than waiting for the PSA to rise to 0.4 before
taking action, you could have seen 2 doublings and started treatment
when the PSA hit 0.2, the point normally associated with biochemical
failure.

Again, it's not clear that recurrence is what you're dealing with.
But even if an upward PSA trend is confirmed in future readings, it's
not the end of the world.  There is a lot of time between biochemical
failure, clinical failure and metastisis...and a lot of things to be
done to stop or slow disease progression.  If and when an upward PSA
progression is confirmed, use the time to consider what tests you
might want run in order to differentiate between local disease
recurrence or systemic disease.  Treatment selection depends upon the
answer to this question.  Best wishes and good health for you and your
husband...Ron

Linda, the answer in my humble opinion is, "Yes, you are worrying
needlessly."  Aside from the old adage about not worrying about what you can
do something about and anything that you can't do anything about, a 0.1 is
so little different from a <0.1, that it's an insignificant result.

A liftime of 0.1 is the goal of everyone hear.  If it goes to .2, then .3,
act on it.  But .1?  Never.

  Personally I'd be more concerned that he's not interested in your "help",
than those meager numbers you presented. Probably nothing.... if something,
still many choices to make it nothing again. He's still a young man,
probably with more knowledge about all this than all of us combined.

If I recall properly someone else had a case where the lab simply failed
to put the "<" in front of the .1.  Best of luck.
DanR

"I'm concerned that the cancer has recurred and may be spreading to
other parts
of his body. ...  Am I worrying needlessly...or should this be
followed more closely?"

Linda, from what I undertstand of the test, PSA level can fluctuate
over a several hundreth range purely due to analytical discrepancies.
A .1 as opposed to a <.1 does not mean PSA is even detectable, much
less that he has recurred. If he has another .1 or greater in 3 mos.
then you can start to plan the next step, but I would not worry about
it now. You might also insist on the ultrasensitive test that reports
to 2 decimals.

Bill Denton
RP 2/12/02
Memphis

Linda,

I wish every husband and wife could communicate with each other
and accept each other's help - intellectually, emotionally, and
physically when they have a serious personal crisis.

Too many of us men have been raised to believe that if you deal with
problems on your own, you're a stronger man.  The truth is, of course,
that you're not stronger for dealing with problems entirely on your own.
You're just lonelier, and you spread the loneliness to your partner as well.
Hoping to suffer in silence and protect others from suffering, you wind
up increasing the suffering all around.

Lots of us have been down that rocky road.  The lucky ones among
us have discovered that there are alternative roads to take.

In this awful situation, it appears that your husband has had one great
piece of luck.  He has a wife who cares and wants to help.  Some of
the guys here (not including myself) haven't had such luck.

Best regards,

  Alan