I am still of the opinion, that unless one has such a blatant post surgery PSA, as our beloved Sonny, it is best to wait. Neal, I know you well enough to know that you will wait and see what the numbers say, and will do what you think is best for you.
Even though Radiation Oncologists get paid the big bucks if they reel in a new customer, from the three that I interviewed, all of them now believe it is best to wait until there is real evidence of reccurance, with 3 consecutive rises in post PSA above .10, before engaging in radiation.
Invoking Sonny's name again, his post surgery PSA was so high out of the box, that it was the most sensible and prudent thing to do, by starting a pretty vigorous round of IMRT as he underwent.
In my case, some wonder at .16 what the big concern was, the decision I made was based on the concensus of opinion that with my pre-surgery PSA velocity, and recurrance at or before 9 months post surgery, even with a pretty clean pathology report, that it was in my best interest to undergo salvage surgery, which was the last thing I wanted to do.
Like all things PC, there is no one size, its still guy by guy, case by case.
If you are having incontinence problems, most doctors feel its best to get that under control before undergoing post surgery radiation, as it tends never to improve upon the point you begin, and in some cases, can get worse. But its important even on that point, that is not written in stone, and it varies of course, case by case.
It is also not written in stone, when is it best to start, what line in the sand with the post surgery PSA level, again, depends on the circumstances, my doctors agreed that I needed to stay way under .50. Again, it was because of my track record with the velocity issue. Other men here began radiation way beyond .50 and even over 1.0 in a couple of cases I seem to remember and are doing fine.
The decision is very important, and one has to factor in all the criteria for your own case and have excellent communication with your doctors, both urological and radiation.
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, no problem post SRT
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, 1/19 - Corr Surgery #4, Caths #11 and #12 same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days