Eight Years after Surgery PSA up DANG

So the important findings were that you did have a positive margin at the right apex, and that your pathology Gleason score was 3+4. Your stage is T2 (I can't tell if it's T2b or T2c without seeing the diagram, but it doesn't really matter).

So the bad news is that salvage radiation will be required if you want a cure, and the time to do it was in 2008 - which is to say that it's long overdue, and you don't want to wait. The good news is that with your positive margin, you can pretty well guess there's a tumor growing in the prostate bed near where the right apex was. The other good news is that hormone therapy probably won't do much for you.

If you have an excellent radiologist who has experience at such things, an mpMRI might be able to show just where the recurrence is, and they can do a boost of radiation to that or those places, as long as there are no critical structures in danger of getting over-zapped there.Otherwise, the standard of care is to zap the entire prostate bed uniformly, and unless the planning CT/MRI shows enlarged nodes, with your low PSA and Gleason score, they can probably be spared.

- Allen

Tall Allen, Thanks, you seem to really know this stuff. Got more information from you than the doctor. Here is the diagram chart that I got with my records.
VIEW IMAGE

Everything that the Tall One said.

With your three-year doubling time you can be fairly sure that the radiation will do you.

Keep us posted. Good luck.

56,

Remind us where you live (nearest big city) and maybe someone will have a recommendation.

I've done radiation. it wasn't bad. Every weekday for seven weeks I would go to the center, enter the lead-lined room where a pretty young lady would hand me a small towel to preserve my modesty while I dropped my trousers and hopped up on the table. Then she would lube my pubes with cool gel... and then she would...

ultrasound my bladder to make sure it was full, zap me with xrays and charge my insurance company another twelve hundred bucks.

Ok, so the story doesn't end as well as it starts. But it wasn't bad.

Radiation doesn't usually cause incontinence but it can make it worse if you've already got it. As for ED... well, it doesn't help matters much, but the effect is gradual during several years after treatment and it is hard to sort it out from just getting a bit older.

THIS..... is where the Tall One shines!!!! Great insight TA, incredibly helpful and we all (again) are learning more!

Sounds like you've got plenty of positives '56 - my best to you as you continue down this path.

The only place I know of in Oregon is OHSU Knight Cancer Institute in Portland. They would probably be able to give you that mpMRI I mentioned. They might have locations around the state as well. Perhaps call them to arrange a consultation.

Image guided radiation therapy (IGRT) is needed when there is a squirrely prostate in place, but less necessary when the prostate is gone - they just use the pelvic bones as their visual reference. But if they want to use the mpMRI to zoom in on a specific place, they might want to add image guidance for extra precision. It usually involves implanting gold fiducial markers (the size of rice grains). They normally do it into the prostate, but sometimes for salvage they do it into the prostate bed instead. All of these are details your RO can better explain.

- Allen

A new analysis demonstrates that a PSA≥0.03 is a better indicator of recurrence than the traditional value of ≥0.2 when men have positive margins. (I just wrote a review of this which will be published next week.) I suggest that you go ahead and make an appointment at OHSU ASAP rather than wait until June. It may take a while to get seen. These things can metastasize, and you are not taking any hormone therapy that might slow it down. You want to treat while it is still curable.

- Allen

56pontiac,
I agree that this forum is a wonderful place, a sea of collective knowledge. Like you, I pop in from time to time, report in, and move on. Good luck on your renewed battle, and thirst for knowledge.

Tall Allen,
((PSA≥0.03 is a better indicator of recurrence than the traditional value of ≥0.2 when men have positive margins.)) This caught my eye. Since May 2011 (negative margins) I have had two PSAs at 0.03. My last PSA was 0.03 in DEC 2014, the other 0.03 reading was 2 years prior to that. All other PSA tests, 6 months apart, were undetectable < 0.1. The two PSA 0.03 results were from the same lab, all other tests from two other labs. Labs were never chosen, insurance company tells me who to use, and my health insurance changes often. I am interested on your take/opinion, since I am right at the 0.03 mark, thanks.

Sagittarian,

The study I referred to only applies in cases where there is "aggressive pathology"- Stage 3 or 4 or positive margins. It does not seem to apply to you. The point is that about half of men even with aggressive pathology wind up getting unnecessary adjuvant radiation. You can read my review of it here:

When should the patient and doctor consider salvage radiation therapy?

- Allen

56pontiac,
I apologize, if your thread seemed to be commandeered, good luck to you. You have 10 years on me (I'm 57), lets see if life allows me to go that far :>

Tall Allen,
Read article, curious what results of pending studies will be. Being T2 and 0.03 sure is cutting it close, and yes with negative margins. A PSA of 0.04 will put me back on duty with frequent visits to this site, and taking sips from the fountains of knowledge.

Cheers All !

Hi Pontiac,

I took a look at your post surgery pathology report. All I can say is I wish mine were as complete at that. The diagrams are very helpful. Looks like your tumor extended to your right apical margin. That is the part where the prostate attaches to the uretha that then passes through the penis. The pathology indicates that the tumor extends to the right apical margin.It is possible that microscopic cancer escape the prostate and that is what is causing your PSA to rise. You may be looking at SRT in the future or a combination of ADT at SRT.