Is this Recurrence?

Thanks for starting a new thread.

I think the problem is because you're talking to a urologist, rather than a radiation oncologist. It is probably true that every urologist there would start him on Lupron - that's because they are dealing with him as if he were a post-prostatectomy patient (which is what they know about). Any competent radiation oncologist would know that there is no evidence of a biochemical recurrence, let alone a clinical recurrence. PSA after radiation will fluctuate. Bounces are common and expected. A biochemical recurrence would be called if his PSA rose to 2.14 (nadir +2). Even at that point, many biochemical recurrences are not clinical recurrences - just some prostatitis acting up.

The nadir he reached, 0.14 ng/ml, is very good and is prognostic for a full, enduring cure (especially considering he was only intermediate risk). That's your best-guess assumption until real evidence contradicts it. If you like, go to PSA tests every 3 months, but that's really all that's called for. BTW- One does NOT look at PSADT before a recurrence after radiation - it is only a valid metric post-prostatectomy or after clinical failure. Again, his urologist is treating him as if he had had a prostatectomy. Lose that urologist before he does real harm.

He does not need a PET scan and he does not need a biopsy (let alone Lupron shots!). Those are for after a biochemical recurrence when one wants to see if the cancer is still curable with salvage brachytherapy (as it is about half the time).

I am not a doctor, and I would encourage you to talk to a doctor (a radiation oncologist) who actually knows about this sort of thing. Robert Timmermann at UTSW would be a good person to talk to. I'm sorry that ignorant urologist caused you so much unnecessary anguish.

A PSA bounce in the 18-48 month period following radiation treatment as the initial treatment is very normal and positive. That is what it looks like to me. There could also be some prostatitis as he still has the prostate. Continue to monitor the PSA and see what happens. If it goes up over the nadir+2.0 then it may signal PCa growing that may need more treatment. At that time, scans would be more reliable to attempt to determine whether the PCa was still local or systemic. If local, then salvage radiation can be used. If systemic, then ADT would be the next course of treatment. This would then determine the treatment protocol to pursue. I agree with TA that you should be in the hands of an expert ro rather than the uro.

Time frames for radiation bounce and even reaching nadir are general and often men will be outside the ranges. For example, it is generally stated that radiation treatments should reach nadir in about 36 months, but one member on the board took about five years. You look like the nadir was reached in a little under 36 months in November 2015. So the general ranges are just that.

When things happen outside the general range, that is a good time to do more investigation. If the PSA trend stabilizes or reduces, then you will know it was a bounce or some infection. If it continues a gradual increase, it could be more indicative of PCa growing and need further investigation and perhaps treatment. My doctor has kept me n a three month PSA schedule due to my high risk dx. At some point we will probably reduce the frequency. Given your recent increase you may want to go to a three month PSA schedule to keep a tighter watch on the trend.

So, the link didn't work - but here is the part of his profile that resonated with me.


“Many times we see patients who have already been diagnosed, and they are wondering what the next step is,” Dr. Laine says. “People bounce from place to place, perhaps getting blood work here and imaging there. Nobody has sat down and put it all together for them.

“Part of the service I try to provide is being well-versed and knowledgeable enough to inform them of all the available options. Then I can help patients intelligently weigh the pros and cons of each treatment approach.”