The 30% number is the cure rate for all salvage treatments. I would assume that if your pre stats were low and the reoccurrance is local the cure rate could be higher, but I really am only guessing.
If all the margins were clear and if all the prostate tissue was removed it is unlikely that the reoccurance would be local; in that event ADT3 is the appropriate treatment.
I think the most difficult thing in any reoccurance is determining if it is local or systemic. You have to know where the PC is before you can treat it effectively. If I ever had a reoccurance I would get every scan available and biopsies to locate the source. If I couldn't determine if it was local I would go to ADT3 without wasting time and incurring the side afffects of any salvage treatment.
The other salvage treatments are seeds directly to the tumor area and cryo surgery. These can be done for both surgical and radiation failures. Salvage surgery for radiation failure is not a very good option. IRMT for a localized surgical failure is a good option.
I disagree with Billy Mac because I think that today's imaging technology can give you a good idea of tumor
location; it's not perfect but nothing is. Color doppler identified the
location and size of my tumor and a telsa 3 MRI confirmed it exactly. MRIS missed it altogether (I was told later that it was a telsa 1.5 machine) Newer imaging technology that fuses MRIS, Color doppler, DEC MRI, and diffusion MRI can give you a pretty good idea of tumor
location and size and posssibly agressiveness; then there is always 3D saturation mapping. Before I want anyone cutting on me I want to know if the cutting is going to get it all. If not then I'm going to something else that will. It's just common sense. I'm forunate I found a doctor that willing used all the newer scanning technology. All my previous docs weren't aware that it even existed and never gave me that option and I know now that the recommended surgery would have been a failure.
64 years old.
I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.
In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.
I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.
A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.
Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,
I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.
The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.
As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive
Awaiting schedule for seed impants