If salvage radiation fails -- what next?

Arcticfox44 · New User Joined: 05 Sep 2009 Posts: 6

Hello - I first posted in this forum on Sept 8. The topic was "PSA tests after salvage radiation". After a second test on Sept 7 confirmed the rise in total PSA recorded a week earlier, I sent the results to Dr. Mike Morris's office at Sloan-Kettering. He specializes in advanced prostate cancer. My question was whether I should move forward my previously scheduled appointment for Dec 22. Their reaction was definitely "Yes", and I'm going to New York on Oct 1. I'll have another PSA test, an MRI, bone scan and CT scan on Oct 2, then see Dr. Morris on Oct 6. His office has indicated that I shouldn't expect to have to stay in NY for an extended period. But it's not clear what will happen next. Of course, I can simply wait and see what the tests show and what Dr. Morris says, but I want to make the best use of my time in the U.S. since I live far away in Cyprus.
My hunch is that with total PSA still only around 0.4 to 0.5, these tests aren't likely to reveal much (if anything) more than similar ones I had about a year ago, when my PSA was also about 0.5 before salvage radiation began. I might be entered in a clinical trial if something suitable is on offer. Whether that would mean staying in NY is unclear. Presumably hormone treatment in some form is also an option and could be safely done in Cyprus or some place closer than NY. I have a general practice doctor in NY and will seek his advice, because outside the Sloan-Kettering complex I think I need someone to act as my advocate and, to put it bluntly, pull out all the stops to try to cure me or at least keep me alive.
In my earlier post I touched on second opinions. I'm inclined to think there may be little point in simply going to another big place like the Mayo or the Cleveland or Johns Hopkins, because what could they know that Sloan-Kettering wouldn't? I may be mistaken and would welcome advice.
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Graham

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

ArticFox,

I had a consultation with Dr. Morris along with the tests you mention PRIOR to receiving SRT. I also have a good friend (very informed and personally connected to physicians) that underwent some clinical trials under Dr. Morris.

I agree that as an institution, few places will know things that MSKCC does not know. However, whereas SRT is the STANDARD first line response to surgical failure, there is not wide agreement on how to proceed if SRT fails. Physicians often disagree on:

Starting ADT early as opposed to waiting
Using a single agent Vs triple drug blockade
Constant use of a hormone blockade Vs intermittent breaks in ADT
When chemo is most effective (early on vs late stage)

While I am sure you are in good hands with Dr. Morris at MSKCC, it may just be a matter of getting an additional consultation to consider the options. This would depend on your time in the U.S. as well as financial/insurance considerations.
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History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

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