Back in 2013 my psa was 22.1

The simple explanation is that not all cancer was removed with the surgery. This (biochemical relapse) is not at all uncommon, unfortunately.

Irradiation of the prostate bed (and nodules?) is the usual approach for this problem, sometimes combined with hormone (Androgen Deprivation) treatment to kill prostate cells that have spread elsewhere. I believe that the current (!) action level for this kind of treatment (salvage radiation therapy) is a PSA of 0.03 or greater. Hence, you should be treated ASAP.

http://www.medscape.org/viewarticle/744220_4

I experienced the return of prostate cancer after radical prostatectomy. I understand that no two prostate cancers are alike. But yours seems to be behaving much like mine did. Following is a brief summary of what has happened with me. I think it is interesting and, hopefully, it is worth telling.

I had radical prostatectomy in 1991 at the age of 65. Gleeson score of 7 (3+4) and PSA at 4.0. PSA dropped to 0 after surgery and remained at that level 11 years. In 2002 it was 0.2. It began a gradual rise and reached 1.16 after wo years. I took 36 sessions of radiation in 2004. My PSA continued to rise, indicating that radiation had been ineffective. My urologist said I should go on hormone therapy when the PSA reached 5.0. In 2005 I moved to another city and changed urologists. The new person said we could wait until the PSA reached 10.0. It reached that level in 2007. For reasons too lengthy to explain, we ended up waiting until 2008. By then the PSA was at 20.4. In June, 2008, I went on hormone therapy. The PSA dropped to less than .01. After more than seven years of hormone therapy, my PSA is still at that level. (It is said to be undetectable.) The side effects of hormone therapy have been tolerable. I expect that this would be more of an issue if I was a younger man.

I do not recommend this schedule of treatments; I am not qualified to do that. But it has worked well for me. At 89, I am no road king, but I still get around!

Good luck to you.

Jerry

ROADKING04HD said:

Thank you for your follow up

Thank you for your follow up and good luck to you also.

 

 

 

                                                       Larry

Larry,

As I understand things, Old Salt's simple and clear response is what you are dealing with:  Despite the doctor and pathologist's best ability to analyze the surgically removed tissue immediately following your surgery, somehow, from some location, cancer had escaped the gland prior to its being cut out.  I had my prostectomy in January, and have remained "undetectable" for PSA thus far, and pray that it forever remains undetectable.   But I have studied what the normal sequence of events is should PSA return, and yes, most likely (following some scans) irradiation of the prostate bed and possibly adjacent areas would be the first step.  Clinically, this is still usually regarded as potentially "curative," or a reasonable technique to kill "all" of the cancer.

The avenues usually mentioned for "escape" are perineural (the cancer followed a nerve bundle out of the capsule), a positive margin (some cancer went through the capsule lining itself, although that seems the least likely prospect, given that the patholigist studied the tissue for positive margins), and travel into the seminal vesticles (two glands conturing the bladder, which feed into the prostate itself).  The seminal vesticles nowadays are virtually alweays cut out with the prostate itself, but there are cases in which the surgeon will leave them in.

If you re-read the pathologist's report it might provide you with some clues regarding these possibilities, or just ask your surgeon.

Regardless, radiation is the most common "first step" in cases similiar to yours for "salvage therapy", sometimes called "second line therapy."

My surgeon told me last office visit that things look very good for me, and said that it is "90% likely I would never have detectable PSA again." Of course that means that a 10% chance does remain.   There are no guarantees with this stuff, no written warranties.   But is sounds like you do still have a good shot at curative treatment.   I personally would speak to both a radiation oncologist and a medical oncologist (a doctor who is trained to use hormonal therapy and all the versions of chemo) to get more than one opinion, and then get going on undetectable PSA results again.

Love the screen name !  (For guys who don't know, the 'Road King' is a beautiful version of the Harley Davidson Electra Glide.)

max