Everything about your husband's disease suggests low risk disease, except for one thing -- the relatively fast rise in PSA from 1.4 to 4.6. I think one important question which we may not be able to answer is, "was that rise in PSA from cancer."
One core of small volume (low risk) Gleason 6 prostate cancer typically doesn't manifest with a fast PSA rise.
One problem with prostate cancer staging is that you never really know the true stage of prostate cancer until the prostate is removed.
Assuming it really is a low volume Gleason 6 cancer, his chance of cure is very high with any treatment -- radiation, surgery, and many would say no treatment. Translation -- for the typical low volume Gleason 6 prostate cancer active surveillance (sometimes called watchful waiting) is a reasonable option as data would suggest that the chance of death from this disease over the next 15 years is very low.
I think a detailed discussion with your urologist about active surveillance, radical prostatectomy and radiation is a wise next step. You are always more than welcome to get 2nd opinions.
My only advice is that if you do choose active surveillance (which to be honest is what I would choose if it were me) you must be followed very closely with repeat PSAs (every 3 months) a repeat biopsy, and regular visits to the urologist.
However, as I tell all my patients if you don't think you can be compliant with the followup involved in active surveillance or don't like the anxiety of not treating right away, than you should choose a different option.
1. You are correct, that PET CT is not very sensitive for prostate cancer.
2. Unfortunately, when PSA rises after definitive surgery it is always a challenge to determine if it is from local recurrence or distant mets. In general, local recurrence has a slower PSA rise. However, with the use of hormones, the PSA rise is harder to interpret.
3. I don't know of any data which says radiation is of any benefit in lymph node positive disease.
4. Adjuvant radiation (given after prostatectgomy) is most effective in locally advanced disease (positive margins, extracapsular extension, etc.), but once the disease is in the lymph nodes it becomes very difficult for a radiation oncologist to treat that disease even if they radiate both sides of the pelvic lymph nodes.
Its hard for me to say much more without knowing the entire history, but it sounds like you are asking the right questions and I'm sure your urologist and radiation oncologist can continue to guide your care.
It sounds like you are doing your due diligence. Take your time and get all the information so your father can be comfortable with his decision. There are not just two treatments for prostate cancer. Basically, depending on the Gleason grade and stage, these are your options:
1. Active surveillance/watchful waiting 2. open radical prostatectomy 3. Laparoscopic/robotic prostatectomy 4. brachytherapy 5. external beam radiation 6. cryotherapy
No treatment is perfect and each has its own set of unique side effects and cancer cure rates. Most importantly, whatever approach is chosen, pick a competent and experienced physician (whether it be a surgeon or radiation oncologist)
a PSA of .10 is still considered "cure" by many people. Depending on the institution the cutoff for "recurrence" can range from .10 to as high as .40 in some cases.
Cystectomy (bladder removal) is typically not done unless the pathology is high grade disease (which is recurring) or muscle invasive (always high grade) disease.
I would not rush and radiate the prostate bed area based on a psa of .10. Wait to see if it rises and if so, how fast does it rise?
Don't let one cancer hastily influence treatment of the other. (ie, treat the bladder first how you would normally treat it).
In general the risk of dying from high grade bladder cancer is significantly higher than dying or prostate cancer. In most cases bladder cancer can and is treated without the need for any radiation, so don't let a PSA of .10 change how you would manage both diseases.View Thread
I'm not sure its possible to "overshrink" the prostate. In general a reduction in size would be expected to improve your BPH symptoms. If your symptoms are severe enough to afffect your quality of life, it probably warrants further investigation to see if it is an obstructive prostate problem or a bladder problem. (cystoscopy and urodynamics can help answer these questions). After that your doctor can better decide if you should more aggressively treat the BPH (surgery, in most cases) or focus more on the bladder and overactive bladder type medications.View Thread
Thank you for this post. The natural history at your stage is for the PSA to continue to rise, so this appears to be a good initial response. I don't have any patients on this particular trial, but would be interested to hear how it goes for you. Best of luck.View Thread