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    After prostate surgery
    An_242719 posted:
    I had prostate surgery 13 weeks ago and now have a rising psa(.13). Radiation treatment is now being suggested, but with only a 50% success rate. do they know where to treat and is there a better alternative?
    Gottano responded:
    Funny. That's the same question that first occurred to me. Radiation oncologist said they treat the "prostate bed" (sounded like shooting at the bush where you last saw the rabbit). Follow-up treatment alternatives depend not just on psa, but the pathology report following surgery which your doctor should have gone over with you, explaining the reasoning behind the various options recommended. IMHO unless there is some evidence that the cause of your rising psa is local, I'd want to hear from a knowledgeable source why a second local treatment (vs systemic) is recommended following the failure of the first (surgery). I haven't heard the 50% success rate before for salvage radiation therapy, but in my case (Gleason 9 with extraprostatic extension, seminal vesicle involvement and questionable margins) even without rising psa after surgery, doctors at 3 cancer centers strongly recommended both hormone (blockade) and radiation therapy, citing studies which supported a 20% increased chance of delaying recurrence by up to 12 months (somewhere within a 5-10 year window). I took a pass on the radiation and HT. Had surgery in August 2009 and no rising psa yet, but we're all different. Still, it's probably worth getting a second opinion (or third) from a medical oncologist and radiation oncologist specializing in prostate cancer. Good luck 242719.
    az4peaks2 responded:
    Hi an, - The success of secondary radiation as a potential "cure" for Prostate Cancer (PCa) following "failed" surgery, is largely dependent on whether the source of the recurrence as demonstrated by an "elevated" post-surgical PSA blood test (>0.1 or 0.2 ng/ml), is "localized" or "systemic" in origin.

    Unfortunately, this is seldom easily determined and therefor, most often, a subjective judgment has to be made, based on a variety of diagnostic information that should be available. These include, but are not limited to, age, the PSA at the time of treatment and now, time from treatment to the recurrence, did the monitoring PSA results ever reach traditional, clinically "undetectable" levels (<0.1 ng/ml) and the findings contained in the post-surgical Pathology Report such as Gleason Score, and extent of disease/location.

    Systemic disease refers to malignant cells that have escaped the Prostate and invaded the blood/lymph systems and are circulating within the body or haven taken root elsewhere, in the form of distant metastases. If such cells exist at a size and/or Stage that is unable to be detected with todays technology they are often referred to as "micro" cells or metastases.

    The potential for their existence increases in direct proportion to the "favorable" or "unfavorable" levels of the items mentioned above. When determining the likelihood of "localized" disease, which is the only kind curatively effective by any treatment but Hormone Therapy (HT) and/or Chemo, earlier recurrence is less favorable than more prolonged time-frames. As a group, patients with less favorable (over-all) positive margins, actually have better statistical success rates with Salvage Radiation Therapy (SRT) than do those with more desirable (over-all) negative surgical margins.

    But the effects on decision making should be the conclusions reached by weighing ALL of the diagnostic "clues" involved and the potential risk/reward ratio that they imply. So what do you do if it can't be determined, WITH CERTAINTY, whether the recurrence is localized or not?

    You then weigh your POSSIBILITY for a potential "cure" based upon the above, versus the reality of (widely varying, but sometimes prolonged) remission control offered by HT against their potential for increased morbidity (side effects).

    These are not easy decisions and professional guidance can help sort through the considerations and options, but it comes down to the fact that secondary treatment for, hopefully, localized disease is presently your last chance for "cure" as opposed to efforts to control a chronic disease. Its potential for success, in your INDIVIDUAL situation should be the determining factor, since statistical results are determined by data from large groups of men and cannot be directly transferred to INDIVIDUAL patients.

    Good luck! - (aka) az4peaks
    Jcan6244 replied to Gottano's response:
    Thanks for the response. Had a total of 3 opinions, last one yesterday, and I have decided to go for the radiation. I had the robotic surgery back in Aug., which I was told was my only option,surgery. My psa was 19 with a gleason of 8-9 going in. First psa test after surgery was .02, and 30 days later .12 All 3 opinions felt some possible residual in lymph nods bottom area which was left over. 2 of the 3 opinions felt to skip HT for now. Entering in 2 weeks for 42 daily treatments. Hoping for great results.....
    Jcan6244 replied to az4peaks2's response:
    Thanks for your detailed response, it was very helpful. I had 3 opinions now, and all 3 were basically on the same page, that being radiation. One of the 3 felt to add HT with treatment which I opted not to after evaluating all 3 opinions. The concensus is that after my robotic surgery there was possibly a few cells left in the lower portion of lymph nods. I will be starting end of this month for 42 treatments. Hoping for success.....

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