What to do next?

VascodaGama said:

Salvage treatments
Muffin

Welcome to the board.
Firstly I would suggest you not to rush to a salvage treatment before you get a satisfactory decision on which to follow. The PSA of 0.2 ng/ml may be confirming recurrence (according to NCCN guidelines), but treatment is usually administered when the threshold of 0.4 is reached.

You have not shared details on any image study done before op or now to try to locate the source producing PSA. I wonder if the trial’s protocol includes an image study (bone and tissue) done before radiation.

The info you shared here is indicative of metastases which could be though localized for the negative 9 lymph nodes dissected at surgery. Seminal invasion is a bad prognosis in Gs8 cases, but an MRI of high resolution could have identified the spread at the prostate walls before the “cutting” in July. (Was DRE positive? What is your age?)

The usual salvage treatment is IMRT (SRT) which includes the iliac nodes field, pelvic and prostate bed. Hormonal treatment is better if started two to three months earlier as neoadjuvant. It elevates the rates of success (35%) of the SRT. The HT component will turn the cancer cells' receptors more susceptible to the radiation.
The protocol in the combi (HT+RT) will include a continuing adjuvant HT which may last two years in guys with Gleason scores higher than 8. Surely you will experience the side effects from boths therapies.

RT procedure is done in fractions, every day except Sundays. It takes about 15 minutes each time so that guys may continue their job. Some experience fatigue at some point proibiting them from doing heavy works. In mild cases the affecting effects are burning sensations and the urge to urinate, however that can be handled with over the counter medication.

In your case, you should choose treatment based on the type of the equipment available at the places and the professionalism of the caring team. Modern and newer facilities got better machines for the job and such will reflect in the side effects caused by radiation. This is something you should investigate in advance. The risk and side effects will superimpose to the ones you already got from RP.

In my SRT I did radiation alone (IMRT 68G in 37 fractions). The PSA was 3.8 before RT and that come down to a nadir of 0.05 on the 13th month after the treatment. I had an equal failure of RP (in 2000) similar to yours, with recurrence declared on the six month post OP. (PSA was; 24.2 before RP, then 0.12/0.18/0.26/0.42). From there I was put on WW for six years before committing to SRT but I was a Gs5 (2+3) and negative SV. Failure of SRT was declared when the PSA reached the threshold of 1.0 ng/ml (in November 2010).
At this point I started HT and such has kept a grip on the cancer with a continuous PSA of 0.02.

Try taking the time to educate yourself on the risks of the treatment. Type in a net search engine this sentence; “salvage treatments after prostatectomy”.

Hopefully you find a satisfactory decision on a treatment and get rid of the cancer for good.

VGama

Samsungtech1 said:

Options
If all three of your tests were done at different labs then you have no base line. You need to establish a baseline to see exactly where you are at. Do you know if your cancer has spread. Why would you want treatment when you do not know what is going on. Hopefully someone can give you an answer before you start treatments. If it had not spread to your nerves or seminal vessles then you were clear. It could come back, but where? I think I would wait and see what exactly is foing on. Hard to treat something when you do not know what it is. Get your baseline and then go from there.