thoughts on BIO-chemical recurrance vs, local recurrance.

Hi DHWife,

I hope that I can add a little clarity.  I do not have direct experience in this detailed area of biochemical recurrence, but have read a lot about it.  If I say something wrong, I’m sure someone else with more direct experience will correct me so I don’t lead you off-base.

Firstly, biochemical recurrence (BCR) is the general term given to any rise in PSA after primary PC treatment with either surgery or radiation. 

The BCR may occur locally, in the prostate bed; most typically in tissue next to the prostate or in surrounding lymph nodes, or in the prostate itself if radiation was the primary therapy. 

Or, the BCR distantly in bones or other organs; this is also called metastasis.  Distant metastasis is usually (eventually) marked by bone pain, and later shows up on bone scans, but until symptoms show up the primary evidence available is the rising PSA results. 

The doctor can use some of one's individual case history to statistically predict whether BCR is due to local or distant recurrence, but when the only evidence is a rising PSA and no other symptoms exist, then it is really only a statistical guess. 

Post-surgery, the best secondary treatment for local BCR is radiation.  The best treatment for distant BCR is hormones.  In the absence of knowing exactly what is causing a rising PSA BCR, some doctors will take a dual approach and do both.

This is as I understand it.  Hope this helps…

 Casey, Its my understanding that ,for the most part theres no reliable way to"find it", at least at these very early stages.Prostascint are unreliable and VERY expensive.  . Ive had similar reservations in my situation. Its really a last ditch effort for a cure. Not good odds,but its all we have before the less than pleasant future therapys......turner

 

My uro and Radiotherapist both said that they can't be certain if my raised PSA (BCR) is due to something in the prostate bed or something distant. The problem is that volume of the prostate cells producing this small amount of PSA is too small to show up on a scan or similar.
BUT if you wait till the volume is big enough to show up on a scan then there is going to be too much tumour to treat it adequately with RT, and so much time will have passed by then that mets can be more likely too.

They are going to blast the prostate bed as, if the problem is there, then that should treat it, the proof being my PSA going down afterwards. If my PSA stays up however, then that will suggest the prostate cells were not in the prostate bed and they will have to try something else, eg Hormone Therapy (Which is why they said they don't want to use HT at the same time as RT)

Treating the prostate bed makes some sense as they said that as my staging was 3b there is a possibility that as well as having spread to the seminal vesicles the cancer might have spread to somewhere else close by, equally there was tumor in the bladder neck so there could be some close to that area as well.

Casey is absolutely correct. SRT is a shot in the dark where they are just assuming that the reoccurrance is local. The only way to really know is to do a biopsy and find the PC in left over prostate tissue or in the bed and this is difficult with a very low psa as the pc would be very small.
As Zufus pointed out there are various computer tools that by plugging in before and after data a probability of local or systemic reoccurrance can be determined. Again this is only an estimate, but is better than just a shot in the dark.
It may be helpful to discuss just what causes a local reocccurance:
In surgery 100% of the prostate tissue is never removed; good surgeons remove more than bad surgeons; but there is alwasys something left and these may contain cancer cells.
There may be a positive margin were the PC has leaked into the prostate bed and the surgical margin was not sufficient to get it all. 50% of all positive margins are in the APEX and are difficult to get in a surgical enviornment. Patients having large APEX tumors may do much better with radiation. Historically surgery has yeilded 30% positive margins. Today's surgery are more in the low 20% range.
In radiation failures there could be doe to an uneven dose that left dead spots or the dose was not high enough to kill all of the PC. Margins in radiation are usually not a problem in that the margins are usually 10-15 mm and should get most extra capsular extensions.
JT

Shot in the dark is another way of saying gamble.  It is a low odds gamble, but at this point in the game with a rising PSA, whatelse can be done.

The hope or low odds are, that the PC stayed close to where it started, and took up living quarters in the prostate bed.  Apparently, there is about a 25 to 40 percent chance this is so.  So, nuke the bed, and maybe we can hit the PC.

If we were buying lottery tickets, the odds are fanastic.  If we are talking about our life, the odds aren't so great.

When it comes down to it, we almost have to take another role of the dice.  Come on Snake eyes !

goodlife, your words are better, I was being polite, at best, its a gamble.

What are the odds of side effects , specifically incontinence, as ED will happen with HT, which is the next step after a possible failure? My thought is this, if BCR occurs, with my Path report, odds are its systemic. So Im thinking that with hopefully a slow rising psa I can delay HT, hence side effects, and keep it at bay with alt therapy, then HT, into my 80' or 90's with therapy not yet discovered. These are plans for in the " natural ", In the spirit, I am healed, I DO NOT think that is contradictory to making plans, as a retired air traffic controller, I gots to have a plan, even, if I Hope, I don't need it. Not prosletysing, just informing of where Im coming from. I will revise these plans as I recieve more info from wherever. thanks for ear!!

Amen to your last, specifically the last line. God bless us every one!!!