Recurrence of Psa 4 years later

Six weeks ago PSA .4 from lancorp and now .8. Dattoli says may be too early to go back to sands lake. TKe advodart and come back in 3 months.

Dazed, confused and frankly pissed off.

jliggett,

That's frustrating after all the time you put into IMRT and HT. You already had your pelvic lymph node area irradiated as part of your IMRT, didn't you? What do you hope to gain from more imaging? This may be a good time to talk to a medical oncologist instead of a radiation oncologist.

- Allen

If you've already had a full dose of full pelvic radiation, it's still possible, although unlikely, that you are having a local-only recurrence that may be treated with focal salvage brachytherapy to the prostate bed. But before you try that, you have to do things:
(1) rule out that there is a detectable distant metastasis, and
(2) confirm that there is indeed a local recurrence

The problem is that at your low PSA, it's difficult to detect cancer anywhere. For PET scans like C-11 choline or Acetate, or NaF18, they like the PSA to be at least 2. There are some experimental PET scans, like Ga-68-PSMA PET/MRI (and several others) that seem to be able to detect cancer at the PSA level you are currently experiencing. You have to get in on a clinical trial to use one of those. And then you'd want it confirmed with a biopsy.

On the other hand, it's a lot more likely that the cancer is systemic, whether it's currently detectable or not. In that case, your best approach is to begin managing the cancer with hormone therapy at some point.

So it seems to me that you have three choices: (1) wait for your PSA to rise enough to be detected on one the older PET scans (2) get in on a clinical trial to see if one of the experimental PET scans could detect it now, or (3) talk to a medical oncologist about the appropriate timing for hormone therapy.

That's how I'd be thinking about it anyway. I'd talk to some doctors to get perspective about this.

- Allen

jliggett69:

I was seen by Dattoli after ART had failed, he sent me to Sand Lake for the ferahemme and saw two aortic lymph nodes that he radiated, since then I've been undetectable (a little over 2 1/2 years).

You probably know this because you have spent time there but I would guess that 30-40% of the individuals at his practice were in the same boat I was in and the one you are in now. I haven't had any side effects from his treatment but lord knows I have from the initial ART. (Bladder neck constricture which led to an AUS implant) Everything with this disease is a trade off it seems, obviously my PSA could start rising again tomorrow but for now I don't have to deal with the HT side effects. I've kept in touch with a couple of the guys who were going thru the same treatment I was and they are doing well also. It's, without a doubt, a lot of radiation but for me it has worked out to this point.

Good luck
David