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Bladder/Prostate cancer
TomCov posted:
I am a 70 year old Caucasian male, 5'10" and 240 pounds. Other than the cancer and weight I am in good health (blood work is all in normal range) and feel good.

In 2006 I was diagnosed with bladder cancer. I have had 4 cystoscopys for removal of tumors. I had BCG treatments in 2007 and in 2010. I had a reaction to the BCG treatment in December of 2010 and a BAD case or reactive arthritis. I had another biopsy/removal in May and a rating of 3/4.

In May 2010 I was diagnosed with prostate cancer (Gleason 5+3= and had a radical prostatectomy ( DaVinci). All margins and lymph nodes were clear. Until May of this year my PSA was <0.1 when it came back at 0.11. On June 1, another PSA came back 0.10.

My Uroligist sent me to a Radiologist and we discussed irradiating both the bladder and the pelvic bed of the prostate area. The other discussion was to do a cystectomy and then radiate the pelvic area. The urologist has not had a similar situation before and seems unsure how to proceed. Right now we are intending to wait for another PSA test to be done on July 12 before settling on a treatment.

Any thoughts/suggestions?
Basir U Tareen, MD responded:
a PSA of .10 is still considered "cure" by many people. Depending on the institution the cutoff for "recurrence" can range from .10 to as high as .40 in some cases.

Cystectomy (bladder removal) is typically not done unless the pathology is high grade disease (which is recurring) or muscle invasive (always high grade) disease.

I would not rush and radiate the prostate bed area based on a psa of .10. Wait to see if it rises and if so, how fast does it rise?

Don't let one cancer hastily influence treatment of the other. (ie, treat the bladder first how you would normally treat it).

In general the risk of dying from high grade bladder cancer is significantly higher than dying or prostate cancer. In most cases bladder cancer can and is treated without the need for any radiation, so don't let a PSA of .10 change how you would manage both diseases.

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