SRT Failure?

I had RP (hands-on surgery) for PC in 2002. When eight years later my PSA had risen to 0.4 I had salvage radiation in Jan-Feb 2010.

After the SRT my PSA was consistently 0.00 (measured every 3 months) until I received a reading of 0.01 last week. This is the first hint that the SRT may have failed. I have another PSA test scheduled in July. Can anyone tell me what PSA reading or trajectory would be considered an indicator of recurrence following salvage (as opposed to primary) treatment?

Although I have all kinds of published studies and guidance for the indicators of recurrence following primary treatment, I've found virtually nothing regarding what PSA measurements suggest recurrence after SRT.

My reason for asking is twofold. 1) Obviously, I want to consider future treatment, though probably not before much higher readings or other symptoms. 2) I have a disability rating from the Veterans Administration for Agent Orange related PC. I'm trying to figure at what point I should contact the VA for a reevaluation of my rating based on a return of the cancer if the PSA reading persists or increases.

Given that I had seminal vesicle involvement at the time of my original surgery and an enlarged lymph node was found at the time of the SRT, I'm not inclined to believe that the return of measurable PSA is other than real.
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Current Age 66
--DX March 2002 based on PSA 9.0, DRE, and needle biopsy
--RP April 2002. Pathology report showed Gleason=7 (3+4), plus seminal vesicle involvement. No sign of lymph node involvement.
--Post-surgery PSA dropped to a low of 0.01 followed by gradual rise to 0.4 (August 2009).
--SRT Jan/Feb 2010. Enlarged lymph node near prostate bed noted and also targeted. Took Casodex 3 months during SRT
--PSA after SRT remained 0.00 for 2 years
--PSA of 0.01 as of April 2012

Post Edited (Bohemond) : 4/8/2012 3:45:22 PM (GMT-6)

Here's hoping you're wrong. 0.01 is miniscule...virtually undetectable. I've never seen readings of 0.00. I didn't think such a reading existed, so I'm not sure anything has actually changed for you.

I think if the VA took .01 as a severity increase the government would go broke quicker than it currently is. I'm with others, somewhat suspect that there's been anything other than a reading anomaly. My experience with the VA has been they will believe things are worse when you have a written report from your uro saying such is the case. From the sounds of it, your uro isn't planning on offering that until you're over .03.

My uro considers 3 consecutive and increasing 3-month interval PSA results of at least 0.20 or higher to be BCR. He applies that after surgery, radiation, or combination of the two. After RT, it applies after the nadir (it could take a year or more of falling PSAs after RT to get down to the nadir).

He would not even consider your rise, as he does not believe in ultra-sensitive PSA tests.

142 - Thanks for the link to the thread about your IGRT. Much of it is nearly deju vu. I remember well, sometime around week 4 or 5, the scariest part of my day was getting from the parking garage to the nearest hospital men's room after stood I up from the car. I also commiserate about the unexpected pain of the tattoos -- worse than the biopsy.

If I understand correctly your radiation followed closely after your surgery. Was this part of your original treatment plan, or was it because of BCR after your surgery?

I'm groping for information in a void. I spent nearly a decade writing about (mostly veterinary, but also some some human) medicine--though as a writer, not a medical professional. But when researching my current situation, I keep coming up close, but no cigar, for info about failure indicators of salvage, as opposed, to primary treatment.

Maybe it falls under the same guidelines as primary treatment -- maybe not. Based on my conversation with my radiation oncologist in January, he pointed out the danger that cells that survived 8 years after surgery and then turn up several years later after SRT could be genetically different and more dangerous than those that surrendered to treatment.

I note here that my RO and my URO are nearly opposite personalities. My RO is a skeptic by nature -- "I see the results, but I doubt them." My uro wants to put the best possible spin on everything. For better or worse, my inclination aligns more closely to the skeptical but pragmatic. I want the best information I can find, and I want to follow the footnotes,l so I can plan for contingencies.

Post Edited (Bohemond) : 4/8/2012 7:14:19 PM (GMT-6)

Thanks for the details, and sorry to press for information. Based on what my URO told me last week and what my RO told me in January, there comes a point where there just aren't meaningful studies, and treatment is then based on the individual experience and judgment of the docs. But IMO, it's up to us to pick our docs and to make the decisions as best we can. Funny, I've worked with lawyers also and they're pretty much the same. They can advise, but can't decide.