Ben, hello, you have asked some good questions, and like many things dealing with PC, the answers can vary a lot, advice even from sound doctors will vary.
On the PSA number itself, post surgery, a zero is anything below .10. Too much fuss is made about the ultra sensitive tests. The rises that may occur that mean anything, is when it starts to approach .10 and then when it goes after that.
I have completed open surgery and recently 39 treatments of SRT. With the radiation group I dealt with, the line in the sand was .50. They mutally agreed that salvage radiation was most effective before the PSA crossed the .50 line. THey also agreed that it was less effective if it crossed the 1.0 mark. Having said that, there are doctors that feel ok even at the 2.0 PSA level. Beside the raw number, the PSA velocity and doubling times is more dam**** then a lot of other factors when it comes to recurance.
My medical team considered 3 consective rises post surgery above the .10 threshold as proof of recurrance. So my submission to SRT was based primarily on that. I also was informed that the effectiveness of the SRT with my numbers and velocity issues was in the 30% range.
My one saving grace is that I did have a single positie margin, which could indicate that the remaining PC might still be in the prostate bed.
For me, the radiation was hell, and I documented it here at HW. I also had a terrible time with neck/throat radiation from 10 years ago.
My radiation oncologist did not want to mix the SRT with HT, though there are many that would disagree. The SRT is my last curative treatment, and if it fails, then I would have to consider my remaining life extending options including HT.
This next statement is purely my honest opinion from what you posted, but if you intend to go with RT or SRT, then I wouldn't wait for it to reach as high as PSA of 1.0. I would hit it hard while it has its best curative possibilities for you. I was given 72 gys over 39 sessions, which is a pretty good dose for a salvage treatment. I will know more in the next 3-6 months if it looks effective or not, the preliminary post SRT reading I got recently even disapointed my radiation oncologist.
Please keep us well posted on your situation, and your ultimate choices in what to do next. If you want to talk more in detail, I am open to email, and possibly phone conversation if you think it would help.
My best to you,
David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence: 1 Month ED: Non issue at any point post surgery
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped 9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time