Question about Biochemical recurrence

Retired

Welcome to the board.

I cannot fully understand your inquire. Do you want to know if is there any possibility that the increasing PSA belongs to benign cells?
Or are you inquiring if you can avoid a salvage treatment due to your age, in particular avoiding SRT?

The PSA alone that you provide is not enough to substance an opinion. I doubt that the increase from 0.008 to 0.238 in four years belongs to a piece of benign prostatic tissue left behind. It could be from a cancerous piece left behind or from metastases already set before the surgery. By logic you do understand that benign tissue do not duplicate the PSA in such amounts, unless one is confronting a hyperplasia case (when the whole gland is in place). The number of cells increase so that the PSA increases too. Benign cells duplicate and die maintaining the initial number. Cancerous duplicate and do not die. They take the place of benign (squeezing those away) and travel to other friendly places were they manage to survive and expand.
There are robotic cases where tiny benign pieces were left behind producing serum but such do not duplicate as seen in continuous increases (your case).

SRT can be nasty but administered by responsible and specialized physicians is a friendly approach more than what one may think. The isodose planning can be done according to what it is needed and it can be planned to avoid those areas critical for risks or side effects, at the wish of the patient. It also can be done based on proper image studies (PSMA PET/CT plus 3tMRI) locating the bandit, therefore limiting the scope of attack, avoiding areas of concern.

Hormonal manipulations (ADT) also manage to hold (at its track) the advancement of the cancer if one's type of cells respond to the treatment. This works well during many years and can be administered intermittently, allowing periods of recovery away from symptoms. ADT is also linked to risks and side effects. Some guys experience mild symptoms but some got them nasty. One needs to be fit in terms of heart health and diabetes.

I suggest you to share more details so that survivours can provide you ideas based on their experiences.

Best wishes.

VGama

Unfirtunately such subsequent rises and breaching the 0.2 threshold does indicate biochemical recurrence. Benign cells left behind would not rise psa levels like that. You could probably do hormonal therapy in place of radiation, but it too has sude effects that must be considered. 

Hate to hear that ut looks likely tyat it has recurred,  but it still can be controlled, or even cured .

Completed 39 treatments with confromal low dose radiation for T1c, with no masses and competely encapulsated. Also had BPH (62 grams). 3 of 12 postive needles , Gleason 6 < 50% ca in each needle. Injected with 6 month Eligard and started RT treatment in 06/08. PSA's have been as follows since 2008. Nadir .01 on competiton of radition 6/08. Down from 4.5 on original dx/biopsy. PSAs  have ranged from Nadir of 01.1 to 0.93, (also had an 0.93 & 0.9 draw) with frequent ups and downs in between. Never above 1.0. Had settled in at 0.6 from 7/13 to 0.48 9/16. And now, back up to 0.84 3/17. Been bouncing around as high as .93 (11/09) and low 0.48 9/16.  Numerous draws as Internist and Urologist didn't like variance in PSA progression. Rad Ono didn't have a problem with PSAs,  and was concerned that they were tracking PSAs too frequently. Left RO and continued to be followed by Urologist and Internist. Uro was impressed with drop to 0.48 om 9/16, now his semi-annual draw came in at 0.84 on 3/17 and that will get his attention. Wish I had RP, but that's history. I was deemed successfully treated by RO after 6 years and PSAs not exceeding 1.0. Am concerned that they've been all over the chart and Radiation may not have been the play. Anybody out there with variable PSAs on 20 or so draws approximate 8 year period? Don't know if it is normal or if ca was ever completly eradicated, or it may have come back. Eligard shrunk prostate to 50 grams, and that's what they did RT on. Prostate still has BPH tissue, negative on DRE. On flomax. Urologist did find polyp on prostate, removed it, biopsy came back negative for ca but did have BPH tissue. Other than above everything works fine with U&B functions, sex thing of past. 69, good health, very active, no other problems.