watching it rise

Jeff, with all your PSA readings just in 2010 alone so far, most radiation oncologisits would reccomend starting salvage radiation, at least the 3 I had conversations with. They would probably agree that you do have recurrance in place, and that it would make no sense to let it climb to .50 to begin the radiation. The lower the reading when you start, works in your favor many times. Unless insurance, finances in general, or if you are still dealing with incontinence issues, in my opinion, I would already be meeting with the radiation folks. At face value, and I am no crystal ball reader, it would appear that there is no reason to think that any future PSA readings will be going down, instead of up. Just my take.

David in SC

Jeff, no offense taken. My negative reacation and experience with radiation for the 2nd time in my life is unusual and not the norm. Salvage Radiation isn't a rabbit hole, after surgery, its the best and final curative means to try to beat the cancer, even though the percentages are less then some people realize. I respect your own personal choice, as well as what you and your doctor(s) are comfortable with. There are no guarantees either way, so its never an easy choice. My consent to SRT was tough, and it ended up being the negative experience I was afraid it would be. But if the SRT keeps my PC in remission at this point, then all the troubles that went along with doing it, will be worth it, at least to me and my family. At 57, I am not quite ready to "write" my life away. But it was a tough choice. Good luck in your decision.

David in SC

David, your vote for SRT after what you've been through counts as a pretty strong vote. I recognize it as my only shot at a cure at this point (although I am still hoping that the vaccine approach that is in the works gives us another option). Thanks for your input.
Jeff

Jeff, I can see what your PSA was at, at time of your dx, but what was your PSA record like the last 2 or 3 years before surgery? Did you have much of a PSA velocity issue going on pre-treatment?

Yes, it was a tough, tough decision for me to make, and most of the time, I was 90% against SRT, it was my own uro that kept encouraging me to do it, despite the fears and reservations and potential for it to be problematic. Even as a surgeon, he said with my numbers and velocity issues, he would do it in a heartbeat. That's why each guy here, despite the best advices and encouragements for treatments or secondary treatments, has to make tough choices in the end for their own journey. Never gets any easier.

You got my support for whatever you choose to do or not to do.

David in sC

David, I didn't get my PSA numbers for any significant time before my diagnosis. I can get them from my GP, whatever they may be, the next time I see him. Like most, at the time of dx, I hardly knew what PSA was, and I was pretty overwhelmed when I was told. What I know is that my GP considered my PSA to have increased from normal levels 2 years earlier to the reading in July, 8 months before my surgery. That reading was comparable to the 7.9 that I had just prior to surgery in March of 2008, although I don't have a record of what it was. I believe that for the 8 months prior to surgery, my PSA did not change significantly.

Thanks for the links, guys
I may just ask my doc for a referral sooner than later.

Well, after a sleepless night, I saw the rad oncologist yesterday, very sharp guy. I was surprised by a few things:
First, in spite of my negative margins, the working assumption for radiation therapy is that the margin was actually positive instead, and it just wasn't picked up in the pathology. He said this is much more common that you might expect. So, instead of what I expected, which is that the radiation was going primarily target lymph nodes, the IGRT is directed at the prostate bed. There are some lymph nodes that get hit, but my impression was that they are more as a matter of course. This is actually a good thing, in that they can do a better job of avoiding the rectum and other organs that we would prefer not to irradiate. I am particularly concerned about this, since I have colitis and am concerned about a flare-up.
Second, it was my impression that the 70-72 grays planned would be the lifetime dose for my body, and therefore radiation for any other reason in the future would not be an option. He said that the radiation is only a lifetime dosage for the organs/tissue hit, and therefore, if lymph nodes or bone are found to be involved in the future, and they have not yet been hit, they can be irradiated. I also found this as good news.
Third, their planned treatment, regarding filling the bladder, is different from what I have heard on the forum here. He said that they were having so much trouble getting guys to have and keep a full bladder for the treatment, that they have adopted a different strategy. They want you to have a half-full bladder: empty 1 hour before treatment, and immediately drink 8 oz of water, and then do not urinate before treatment. I suppose as long as this procedure is repeatable, it is effective.
Sooo... in spite of the odds being only 40-50%, and the potential and likely side effects, I have opted to start IGRT treatments beginning in early August. I am much more closely following each of your journeys that are now the same as mine, to get a better idea what to expect, with some trepidation. I am grateful for the information and support that is always present on this forum.

Im_patient,

My situation seems similar where my margins were also deemed negative but still had a rising psa afterward. I saw my radiation oncologist once the psa hit .3 and agreed to start SRT about a month later this past January. He added that negative margins were not conclusive. As you can see from my stats, I had a psa test 5 weeks into the SRT and it had risen to .4 but the oncologist didn't seem to be concerned (offering the explanation that it may have been that level at the beginning of SRT).

Last week I got my first post SRT psa after 10 weeks and it came in at .2 (not undetectable yet but going in the right direction). He also said the radiation can take up to a year.

The radiation oncologist is a big believer in taking D3 and fish oil (I'm taking 4000 IU D3 and 3000 fish oil) to help minimize bowel problems. I had/have tolerable side effects. The most noticeable was fatigue (I was very functional but hit the hay early and the walk upstairs was long some nights).

I feel that the SRT was worth the shot.

Our best to you and the others,
Jake