PSA result came back with 0.2 ng/ml - 3.5 year after RP

update 

PSA = 0.2 (07/13/18)   - was 0.2 (6/20/18)

Had a consultation with RO today (7/25/18).  RO surprised that I had a recurrence given negative margin, no cancer in nodes, cancer contained in prostate gland etc... say it happens to 9% of the patients. 

unlike URO (who ecommends RT only), RO recommends combined approach (RT and HT) to maximize cure before PSA hits 0.5.   Protocol: 2 Lupron injections (3 months apart) and concurrently RT (7.5 weeks). 

I was worried about short and specially long term side effects.  The big question is wait a bit say 2-3 months to check PSA or dive into treatment next couple of weeks. 

Appreciate your comments. 

VascodaGama said:

My similar experience just for reference

Sab,

This last PSA result signifies that your cancer is hormone dependent. Lupron has driven your circulating testosterone into castration levels (< 25 ng/dL) depriving the bandit from having it so that the bugger gone into submission. ADT works by turning the cancer indolent but the bandit never dies. It continues living using other means for survival such as feeding on the androgens from the adrenal gland (approximately 5% of total in circulation) or even from low levels of the powerful dihydrotestosterone which is refined from the low volume of any androgen still in circulation. Surely a fewer number of low aggressive cells die in the process.One should note that our body needs androgens to function so that we cannot eliminate them (or the sources producing it) all for good.

ADT is palliative. Radiation (RT) in the combo is the killing weapon. This is the blow we all aspire to occur from a treatment. Delaying RT can be done but in this battle of palliative weaponry the bandit becomes the winner for giving it the opportunity to adapt to the newer environment of low testosterone. These buggers manage to modify their androgen receptors and in time cause refractory by starting to produce androgens by themselves. This is human's natural means of adaptation and survival as explained in Darwin's theory. Our cells, benign and cancerous, got the switches require to survive if given a chance.

I know of guys that did ADT as solo prime treatment controlling the advancement of the cancer for over ten years. I myself am in IADT (intermittent approach) since 2010 after failed SRT. However each case is different and nobody knows how things turn out if not by experience.

Statistics say that salvage radiation in RP recurrences work better at unmasked PSA levels not much higher than 0.4 ng/ml. But the best results can only be expected from cases where the radiation planned field includes the whole cancer, which assurances at present days with available tools seems to be an impossible mission. SRT is typically done on guessing based on past experiences (higher number of successful cases). One needs luck in the process.

I have followed similar steps to yours at RP recurrence in 2001. Salvage radiation was also at the time the recommended standard but there were no fixed PSA thresholds set to trigger treatment. Radiating in the dark was not in my mind at all and therapies based on assumptions did not satisfy me. I researched and did all I could to locate the hidden bandit. ProstaScint and PET were the best options but these in those days used isotopes not totally specific to detect PCa. A famous oncologist recommended me for WW (AS in those times) allowing time for the cancer to develop further and become bigger to try detection in a scan. I did all sorts of exams every year till 2006 without a successful detection. The results were all false negatives to the exception of the PSA that grow from 0.42 to 3.60 along the 5 years. Salvage radiation was also done solo (ADT was not yet recommended in combies). Recurrence was diagnosed again in 2010 when I started the present IADT.

I had the ball in my hands back in 2001. You got it now. Time to roll it in your favor.

Best,

VGama