reading was 0.52, and three weeks ago it was 1.01.

pathology lab confirmed that the tumor had not spread outside the prostatic
capsule. So what can be producing the PSA?

that can only mean, as I see it, that some malignant cells escaped when the
biopsy needle punched several holes through the prostatic capsule about four
weeks before the operation.

I go for?

intact, but the important thing was to get rid of all the tumor. The vital
nerves didn?t survive.

I once consulted a radiation oncologist about the benefits of surgery vs.
radiation.  At one point, he made the following comments:

1. The surgeon _thinks_ he took out all the prostate tissue, but
    he can't know for certain.

2. The pathologist _thinks_ the margins are clear, but he can't test
   every cell on the surface of the removed tissue.

So there are really a number of possibilities.  I don't know if escaping via
the biopsy holes is one of them.  One possibility could be that trace
amounts of prostate tissue remained after the operation.  Another
is that trace quantities of tumor cells had already penetrated beyond
the prostate before the operation.

At this point, if I were you, I'd ask for a consultation with a radiation
oncologist and/or a medical oncologist.

One thing I'd ask about is an immediate beginning of hormone
suppression therapy.  That's pretty easy to take (my main side
effect was hot flashes).  It may be that hormones alone will suppress
the cancer for a number of years, after which it could still be a number
of years before any symptoms appear.

If the oncologists recommend radiation, the HT might hold things in
check while the radiation is planned and scheduled, or while you're
waiting for appointments to find out if radiation is worthwhile.

I've had some external beam radiation, and it was not difficult at all.
Five days a week you go in and lie still on the table.  You feel
nothing at all during the treatment.  After about two minutes of the
machine moving around and zapping you, you pull your pants up
and go about your business.

In order to determine whether radiation will be beneficial, they might
try a CAT scan and/or MRI scan to see if they can see any cancer
in the bones or prostate bed.  My understanding is that if they see
it in the bones, curative radiation is not possible.  If they don't see
it, they might try radiating the prostate bed.

Good luck.

   Alan

It is not possible to be certain about such things, but most likely some
cancer cells with metastatic capability escaped before the surgery and
managed to survive in your body, and eventually to multiply.   It is
possible, but unlikely that this resulted from either the biopsy or the
surgery itself.   Probably, it happened well before either.

You don't say what the Gleason score was.  If it was in the rage 5-7,
and as you indicate, the post-surgical pathology report indicated
everything was okay, your chances of being PSA free at 8 years,
according to Sloan-Kettering was around 95 percent.  That is pretty
high, but it is not 100 percent, so one in twenty such cases will show a
PSA increase.  It appears you were just very unlucky.

I don't see any reason to suspect this.  It is known that cancer cells
escape the prostate all the time, but don't survive in the body.  In
your case, obviously some such cells did survive, but it appears your
body kept them under control for an extended period of time.  Just when
they left your prostate is impossible to determine.

You really have to discuss that with your doctors.  We here are just
prostate cancer veterans like yourself and don't have the expertise of a
medical professional specializing in prostate cancer.   You may want to
get more than one opinion.

Having said that, let me add what I know.  It is possible the cancer
cells have been living in the prostate bed and never left that area.  In
that case radiation to the local area may cure it entirely.  Your
doctors may be able to suggest some tests which will help determine if
that is the case, and they will also know how likely it is 8-11 years
after surgery in a case like yours.   If it is determined that the
cancer has escaped to distant sites, the standard treatment is hormone
suppressing drugs which cut out the production of testosterone, which is
needed by most prostate cancer cells to grow.   There is still some
difference of opinion about when to start such therapy.  In most cases,
it eventually fails, but it can take a long time.  Again you have to
rely on your doctor's advice, but perhaps you should find doctors with
differing opinions about that and one who has not yet formed a firm
opinion about which side it right.

The good news is that it will probably be quite a long while before you
show clinical symptoms of spread, even if the cancer has spread to
distant sites.   This depends on Gleason score.   See Patrick Walsh's
Guide to Surviving Prostate Cancer for details.  (Walsh is one of those
who believes that you should wait for clinical symptoms before beginning
hormone suppressing drugs.)   The drugs should keep you healthy for a
while after that.   There is a very good chance you will die of
something else at a ripe old age and never be seriously bothered by your
prostate cancer.

Best of luck, whatever you decide to do.

I cannot imagine how frustrating this must be.  I was in the clear for a
year once, and less than a year the second time (and this is a 3 strikes and
out disease for the most part).  But, had I gone 11 years, I would have been
quite certain that I was cured.

You and a very few people like you are why doctors are not  willing to say
you are cured.  The closest I've seen is when a medical journal or a doc
will say, "15 years is considered to be...."  But, even at 15 they hedge.

You might have had one solitary cell, or so few cells as to be no problem
for your immune system to keep them at bay.  They lived or were dormant, and
your body kept them in check.  Now, it is not.  There is a couple of
possible reasons, but the most pertinent point is that you still have cancer
and the cells are multiplying.

before

survive.

At 77, I think you are on the cusp.  Your PSA has gone from less then 0.1 to
1.01 in three years.  I do not know how to figure the doubling rate, but it
seems like it is about 1 year.  So, next year, you may be 2.02, then 4.04,
and at 80, 8.08.  The question you have to ask yourself, and be honest in
answering, is how long are you going to live regardless of the cancer.  If
you think 90 is an accurate assessment, I would look into radiation of the
prostate bed.  Or, since you have no sexual function left, hormone
treatment.

I do not think you are going to die of prostate cancer no matter which
solution you decide.

hi frank - simply put, you have prostate cells generating psa.  

that said - you know you don't have a prostate, so you  and i both know
what's the answer is.

that said - what are the options.  you still and radiation treatment
available to you.

i, myself, feel that is the best way to go at this point.  

there is different types of radiation and it has come a long ways since
you last had your RP, so you may want to do your homework before signing
up for one.  they don't have the horror stories like they use to.  

with all this said, that should kill those little critters and knock the
psa back to <.01

if, and only if, does it climb again, then you still have HT to look at
and with your numbers right now, i would have to say that by the time,
if and when they would ever happen, you might be watching tv channels
from the moon.  

FYI - the doubling rate is NOT linear.  it increases as the growth of
the cancer increases, therefore producing more psa.  because of this,
this is an indicator - and that is all it is - of how fast the cancer is
producing.   to clarify this on a personal note, you said that your psa
was .52 in august and 1.01 in january which is a span of 5 months tops,
depending on when the blood was drawn.  so, right now, you doubling rate
is at 5 months.  but be advised, that you could pull your blood in 3
months and it could be a 2.00, which means that the cancer has doubled
again. now, if you pulled it the blood in 3 months and it was 1.2, then
that would mean that the cancer has slowed down.  it is only a indicator
of what's going on inside your body.

that is why, you questioned your rising psa level.  that is what's going
on.  it can still be knocked back down with no problem right now, and i
want  you to know you are in a pretty good position in that respect, but
like life, waiting decreases the odds as the opposing team gets more
hits in.  

hope this info helps.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional

Frank,
I'm a radiologist who performs prostate biopsies (and all other
flavors of needle biopsies).  I've also had PCa and a prostatectomy,
so I'm a legit member of this club.
The question you ask about the prostate tumor cells being released by
the biopsy is a very interesting one and one which we have asked
ourselves for years.  The official term is "seeding" of the needle
tract with tumor cells.
It unquestionably happens rarely...most notably with renal cell
carcinoma where tumor nodules have actually later been discovered
along the needle tracts.
I've never seen this described with prostate biopsy but it is
certainly theoretically possible.  I suspect it is vanishingly rare,
if it occurs.
What is more likely is that although both the surgeon and pathologist
were confident in a complete resection 8 years ago, a tiny amount of
either normal prostate or tumor was left behind.  It could also be
that an undetectable metastasis had already occured.  Unfortunately,
there is virtually no way you will ever know for certain.
While a variety of treatment options are available, I suspect a course
of
"watchful waiting" will be prescribed for you...if it took 8 years to
recur or show up, chances are excellent that it won't bother you for
the rest of your normal life span.
That said, speak with an oncologist or radiation therapist for their
opinion, as I'm neither.
Good luck, CPW

eleven

before

1.01/0.52 = 2^k
so log 1.9423 = k log 2
so  0.2883 = 0.3010 k
so k = 0.958, or close to 1,
so the doubling time is about 5 months.