Recurrence?

My first post on this site. Looking for some thoughts on my situation.
RP in June 2002. Psa was 3.3, age 51. Margins negative, 3+4 Gleason. Psa has been undetectable until 2015 when it was 0.13 in 2016 went to 0.22 then this Oct 2017 0.24. Saw my urologist this summer and he said everything is fine not to worry said wouldn’t do anything until psa hits 0.4 or 0.5 then maybe radiation to prostate bed. I have Crohn’s disease although not currently active I have had 2 resections 1 in 1975 and another in 2010. Any comments on my situation, has anyone had radiation who also has Crohn’s.

AA73

I would start the search for a great radiation oncologist now. Often urologists wait too long to suggest SRT. If there is a recurrence, the surgeon's job is done and it is time for the RO to take over. Find that person now.

I agree with JNF -- You should be talking with an RO, not a Uro. Men who had SRT while PSA was 0.2 or less had half the failure rate than men who had SRT when their PSA was >0.2-0.5, and only a quarter the failure rate of men who had SRT when their PSA was > 0.5

/pcnrv.blogspot.com/2016/09/very-early-salvage-radiation-has-up-to.html

This study was only on 18 patients with inflammatory bowel disease, but none had significant bowel toxicity when treated with IMRT:

/pcnrv.blogspot.com/2016/08/radiation-treatment-of-men-with.html

In the study I linked above, they found that the time until treatment had no bearing on whether SRT was successful. Only the PSA at the time of treatment mattered. The updated Stephenson nomogram no longer uses time until BCR as a prognostic risk factor for SRT success.

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html

its !@# crazy that you have had BCR 13 years from RP. Looks like PC is always here to stay. Thanks for posting and please do keep coming back. The many articles I have read looks very positive at your recurrence as the more time it takes for PSA to rise after RP, the more the chances that it still is localized and can still be cured.

This is from a Harvard article

Scenario 2. Sometimes the PSA falls to undetectable levels for several months following radical prostatectomy, and then begins to creep up. Typically, a man in this situation learns during one of his follow-up tests that he has experienced a biochemical recurrence. If the PSA level rises within the first year after surgery, it usually indicates metastatic disease. The treatment option most often offered is hormone therapy (either intermittent or continuous).

Scenario 3. The PSA does not begin to rise until a year or more after surgery. This is more likely to indicate localized disease, although it is possible that the disease has spread. Your treatment options depend on the PSA doubling time — how quickly PSA is increasing. If your PSA doubles in less than six months, and certainly less than three months, your doctor may recommend treating the area again, but this time with radiation or hormone therapy, in order to eradicate the disease.

Scenario 4. The PSA rises a year or more after surgery, but the doubling time is slow (a year or longer). This is probably the best scenario of all, as it indicates that the cancer may be localized and not aggressive. In this situation, you may opt for active surveillance — monitoring PSA and periodically having other tests, but not necessarily choosing an active intervention right away.

Salvage options after radical prostatectomy

Most men who experience a biochemical recurrence after prostatectomy and decide to undergo treatment have three options. The best strategy depends on your risk profile and comfort with side effects.

Radiation therapy

Many men opt to undergo salvage radiation therapy. Although few studies have been done to evaluate long-term results, many men do respond to salvage treatment. One study involving 368 men who had initially undergone radical prostatectomy, for example, found that five years after undergoing salvage radiation therapy, 46% remained free of biochemical recurrence, and 92% were still alive; at eight years, 35% remained free of biochemical recurrence, and 80% were still alive. Other studies have reported that salvage radiation therapy is likely to be most effective in men whose Gleason score, PSA level and doubling time, and other clinical features indicate less aggressive disease (see “For more information: Salvage radiation therapy,” below).

Side effects. Be aware that radiation therapy delivered after a prostatectomy markedly increases the likelihood of impotence and may increase the likelihood of incontinence. If you are already incontinent after surgery, then having radiation therapy is likely to make the problem permanent. For that reason, most men who become incontinent after surgery will wait until they regain control over their bladder or rectum before undergoing postoperative radiation therapy.