It may not mean anything, or it may mean that additional treatment is
necessary. It is too soon to know. I would listen to the doctor and wait and
see what happens in three months.

On February 18, mdavids wrote:

(snip)

I'll bet that the uro did minimal testing before surgery and afterwards
grinned and claimed, "we got it all!" The fact is that there is NO WAY
that the uro can be certain that all prostate cancer (PCa) cells were
excised. Especially with a "fairly aggressive" tumor. What, exactly, are
the numbers?

Yes, they pretty much always do when their "curative" surgery fails to cure.

I'm sorry to say that it isn't "back." It never left.

If I seem cynical, it's because I am. I have seen this many times.

If the "doctor" is a urologist, he is not qualified to treat cancer. He
is a surgeon, no more. Granted that there are uros who have studied tx
of cancer, but they are rare indeed.

This case appears to be beyond the capabilities of a surgeon. What is
needed here is a cancer specialist, an oncologist. Specifically, a
medical (not radiation) oncologist.

A positive factor is that the PSA is still relatively low, and for that
reason an oncologist might be able to help substantially. But do not
expect a cure. It could happen, but don't count on it. This is likely
(my amateur analysis based upon minimal information shows) a chronic
condition and should be considered as such. In other words, it is probably
incurable and must be treated as a chronic condition.

But, on the other hand, the information supplied is minimal (frex, what
was the Gleason score??). A med onc, given a complete clinical history,
would be the most reliable source of help.

Lastly: for authoritative and objective information, explore the website
of the Prostate Cancer Research Institute:

http://prostate-cancer.org/index.html

Regards,

Steve J

"Empowerment: taking responsibility for and authority over one's own
outcomes based on education and knowledge of the consequences  and
contingencies involved in one's own decisions. This focus provides the
uplifting energy that can sustain in the face of crisis."
--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled
"The Empowered Patient's Guide."

Which, in turn, increases the likelihood that any recurrence is distant,
thus not subject to RT. OTOH, only RT has any chance at curing a
recurrence, so in the absence of proven mets, RT is still a defensible,
probably preferable, treatment. Thus the delay in trying RT before ADT
is probably justifiable.

I.P.

On Feb 18, 3:54 pm, mdavid...@gmail.com wrote:

Nice of you to be helping your FIL, that's the kind of thing that gets
you a ticket on the bus to heaven.

As Steve J has noted, your post is thin on details.  So let me be an
optimist and offer the possibility that your FIL has not recurred.
Brooks and Mc Neal, two noted surgeons, found in a study of 600 men
treated with RP, that 158 recurred (PSA>0.07 ng/ml).  Almost 9% of
those who recurred  had "a detectable serum PSA level after radical
prostatectomy yet without clinical or PSA progression at a mean follow-
up after radical prostatectomy of 10.3 years. The mean time to PSA
recurrence was 5.8 years, and the mean PSA velocity after recurrence
was 0.028 ng/mL/yr."

Now, if your FIL tracked his PSA and if it didn't show any rapid
(>0.03 ng/ml/year) progression, then perhaps he is in this subset of
men.  Certainly the timing of his recurrence (5 years) and his PSA (5
x 0.028 ~ 0.14 at 5 years) seem to lie within the range observed by
Brooks and McNeal.

I'm surprised that the RT didn't knock it down some, but perhaps it's
such a small sliver of benign prostatic regrowth, that the RT simply
missed it.  I'm also surprised that a rad onc would irradiate a man
with a slowly growing PSA that is only 0.12, so, again, perhaps there
is further information that would convince someone that the situation
really was a recurrence of the cancer and not just PSA expressed by a
small regrowth of benign tissue.  In any case, all is not doom and
gloom...Best wishes and good health, ron

My plight was not as lucky as your FIL's, but it was similar in the order of
events.  And, it is a fairly common order.  I had surgery in 2000.  After
several 'virtually undetectable' findings, my PSA started to rise.  When it
got to 0.37, I had radiation treatment.  Then, a year later, when it began
to rise again and when it got to 0.32, I went on the most common initial
hormone treatment, Lupron, July 2003.  By July 2006, the PSA began to rise
again to 0.145 and I added another hormone treatment, Casodex.

You are correct that the cancer is probably back.  Your doctor is correct in
having a second test three months from now to see if there is a pattern and
to see how fast it is progressing.  You FIL's overall prognosis should not
be adversely affected by the wait, though we all understand the angst.

No one can tell another what to do when it involves one's life.  However, I
will share with you what I will do if faced with your father's situation.

I am 69 years old.  I have had undetectable PSA's since my RP surgery almost
5 years ago.  However, my margins were not clear, so my PSA is checked every
6 months, and I will not be declared "cured" until 10 years have passed.

If in April when I get my next PSA, it is 0.1 or above, the first thing I
will do is have it immediately tested again.  Lab errors do occur.  If it
comes back detectable, the next thing I will do is just monitor and watch
how fast it is increasing.  I will probably switch to an oncologist at that
point.  If the increase is very slow, I will probably do nothing.  I already
have a very minor proctitis, and the radiation would probably make it worse.
The thought of fecal incontinence is one of my nightmares---a concern
sometimes greater than that of dying.  So radiationis ruled out.  I would
hold off on the hormone therapy until I abosolutely have to (if it looks
like the cancer is very aggressive and would take me in a couple of years or
less).  So basically, I have made up my mind to do "watchful waiting" (no
treatment) until the PCa (which is usually a very slow-growing cancer) is
immediately life-threatening and/or painful.  Of course, I am 69 with heart
disease on my father's side, so for each year that goes by, my chances
increase of dying of something else, probably suddenly.

I can't say that that's what I will end up doing, but at present, those are
my plans.  Hopefully, however, everything will go according to Plan
A---continued undetectable PSA's.

Just my $.02 worth of input.

Claude