HOW THEY KNOW.

Good question,
Usually relapse so many years out in a monitored patient is typically not local disease. Various scans can find PCa but only when the tumor is big enough. Unfortunately PSA can rise when the disease is invisible to such imaging. The educated guess is that most prostate cancer relapses are in the prostate bed, but that's still a guess. Many radiation oncologists will radiate many of the iliac and inguinal region lymph nodes as these are avenues the disease travels once it begins to become metastatic.

Then comes in the question of whether radiation therapy is necessary at all. Remembering that the median age of diagnosis is 67 years old today, ten or more years later for most prostate cancer patients may mean they will not need to take on another local therapy if other issues are at hand.

For younger men it's probably more likely they will take another bite at the apple on local approaches to treating the disease.

Tony

Thanks for the question, that's one I've wondered about myself. At 5 years and with slowly-slowly- rising psa, I have given considerable thought to that and wonder what's the best approach. All I have to base my future action on is at surgery, a probable microscopic involvement of left apical margin was noted, but at the time the surgeon downplayed it's importance. That 'probable' has given me many a times wondering about just what they meant. In my mind, it either is or isn't, but I'm not the expert. I have consulted with a radiation oncologist and his plan is to radiate the prostate bed, based on that statement in the path report. I've always had this niggling thought in the back of my mind that there might be more complexity to it than just that. I know I will have a couple years more experience and time to have thought it through so my next contact will have a wider range of question for him than the first time around.

I wish you good luck in your resumed journey, thanks for sharing that with us.

I have a friend in that situation -- 10 years after surgery, PSA emerged again. So they did SRT to the prostate bed and it has not budged the PSA. I think they do it because there is nothing else they can do in these circumstances.

NewspaperLover

I have thought about this as well fortunately I have not had to make a life decision on it yet. But I don't want them just shooting radiation blindly at me without any real knowledge of what they are aiming at. I'm not sure I would let them do it. Partly because of what they did to purgatory and partly because it just doesn't make sense.