7 years post RP - PSA slowly rising - currently .08

TheWife · New User Joined: 08 Apr 2008 Posts: 2

My husband had RP in 2001. The first several PSA tests after surgery measured his PSA at <.1 Beginning in 2004, ultrasensitive assay was used and PSA was measured at .04. It was .04 again in 2005 but has risen annually and now is .08, so PSADT is 3+ years. His PSA before surgery was 5.0, GS was 6 before surgery, 7 at path. report. He had positive margins on one side, no seminal vesicle invasion.

With this low of a PSA value, is it too soon to consider salvage radiation? I know that results are better the sooner radiation is started, but he hesitates to risk the possible side effects if radiation is unnecessary.

Should he shop for a radiation oncologist the same way he shopped for a surgeon for the RP? Is the treatment pretty standard for IMRT at all hospitals or would he be served by going to a distant cancer center? His urologist has recommended someone but we don't really know how to check him out.

Thanks for any advice.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 163

You've asked some thoughtful questions. I can tell you've done some homework on this.

As a layperson who's done a lot of reading on this (and been through RP and salvage IMRT), I think it's way too early to pull the trigger.

The studies by Andrew Stephenson (see my blog) show that indeed, the earlier the better with salvage radiotherapy, but you don't want to start before you know a recurrence is underway. The textbook definition for this has been a rising PSA that has hit at least 0.2. Stephenson says it's optimal to start at 0.5 or lower with the salvage radiation, and definitely before hitting 1.0.

Shopping for the radiation oncologist is a more difficult question. I would get a recommendation from the urologist. Then check to see if the rad oncologist has done a lot of prostate work, look into the person's curriculum vitae, check with the board of medical examination for complaints, etc.

I don't think there's a need for most patients to look outside their immediate city for IMRT. However, if you're interested in protons as salvage, you would need to start thinking and pre-planning for that, since temporary relocation might be required, as well as dealing with the wait list for treatment and getting insurance approval.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

TheWife · New User Joined: 08 Apr 2008 Posts: 2

Thanks, Replicant, you've kind of confirmed what I was already thinking. I appreciate the good advice.

interval · Regular Joined: 11 Apr 2008 Posts: 20

I think that having .08 PSA after 7 year of RP is a good condition. I understand that it rise every year, but if I could be in the patient's shoes I choose a watch and wait strategy. We do not know how old he is to consider a right advice.

vigo

Oh, you're right, sorry - I forgot to post his age. He's 62 now. He was 55 at diagnosis.

I do agree that .08 isn't a bad number. It's the fact that it has doubled, when we had expected it never to rise, that is troubling. He will wait and watch it carefully.

brainman

Uhhh who are we talking about? vigo, are you the same person as TheWife? Very Happy

. No problem if that is the case... just confused about how you know the gentleman's age Wink

.

Anyhow, I too am only concerned because the PSA doubled and seems to be on the rise. It still is low but close monitoring is good advice.

Age really should not be a factor on treatment decisions; what is really a factor is overall the overall health of the patient. If the guy is 90 but still active and vigorous he is a better candidate for treatment than a 50 years old guy with multiple health issues.
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