Hi Steve,

I had a low  postrecurrence PSA doubling time and a low preradiation
PSA level (outcome predictors as per article below). This, I hope, is
influencing my current status.

Just

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Journal of Clinical Oncology, Vol 19, Issue 4 (February), 2001:
Prediction of Response to Salvage Radiation Therapy in Patients With
Prostate Cancer Recurrence After Radical Prostatectomy

- A complete and durable response to salvage radiation therapy
(defined as the achievement and maintenance of an undetectable serum
PSA level) may be the best indication of isolated locally recurrent
disease.
- Several investigators have shown that locally recurrent prostate
cancer may be associated with a significant risk of disease
progression and have suggested a cause-effect relationship between
local recurrence and metastatic disease.Therefore, locally delivered
salvage radiation therapy has the potential to delay or eliminate
progression in these patients. Although the reported response rate
after salvage radiation therapy in unselected patients has been
disappointing, higher response rates have been reported in selected
patients who were treated when the PSA level was low and in those who
had pathologically confirmed local recurrence.
- Preradiation serum PSA level has been shown to be an important
outcome predictor of salvage radiation therapy. Several investigators
have found that a preradiation serum PSA level at a cutoff value of
approximately 1.0 ng/mL predicts a favorable response to salvage
radiation therapy, whereas others have suggested that cutoff value to
be higher, from 2.0 ng/mL to 2.7 ng/mL, or as high as 4.0 ng/mL. In
our study the median PSA level of patients with an undetectable PSA
after salvage radiation therapy was 1.7 ng/mL (mean, 1.6 ng/mL), and
the 5-year PSA relapse-free probability of patients with a
preradiation PSA level less than 2.1 ng/mL was 62%. Our results,
similar to the results of previous studies, also demonstrated that a
low preradiation PSA level is associated with a higher probability
that the patient will maintain a favorable response, regardless of the
actual cutoff level, which is directly dependent on the patient
population.
- Some of our patients who had negative prostatic fossa biopsies also
had local recurrence that remained undetected by biopsies because of
low local tumor burden. Patients who harbor biopsy-detectable locally
recurrent prostate cancer may have a larger local tumor that is beyond
the therapeutic potential of salvage radiation. It is an accepted
principle of radiation oncology that an increasing tumor burden
negatively impacts disease control by radiation therapy.
- Outcome of salvage radiation therapy can be independently predicted
by postrecurrence serum PSA doubling time, as well as by preradiation
serum PSA level. The parameters can be used in combination to direct
clinical decision-making in patients in whom radical prostatectomy has
failed. Although these two parameters are predictive of prostatic
fossa biopsy results, biopsy confirmation of local recurrence does not
seem to provide significant additional prognostic information with
regard to outcome of salvage radiation therapy when the PSA and the
PSA doubling time are known. Postrecurrence serum PSA doubling time
can be readily determined before local tumor burden exceeds the
therapeutic capability of salvage radiation therapy.