Casey is absolutely correct. SRT is a shot in the dark where they are just assuming that the reoccurrance is local. The only way to really know is to do a biopsy and find the PC in left over prostate tissue or in the bed and this is difficult with a very low psa as the pc would be very small.
As Zufus pointed out there are various computer tools that by plugging in before and after data a probability of local or systemic reoccurrance can be determined. Again this is only an estimate, but is better than just a shot in the dark.
It may be helpful to discuss just what causes a local reocccurance:
In surgery 100% of the prostate tissue is never removed; good surgeons remove more than bad surgeons; but there is alwasys something left and these may contain cancer cells.
There may be a positive margin were the PC has leaked into the prostate bed and the surgical margin was not sufficient to get it all. 50% of all positive margins are in the APEX and are difficult to get in a surgical enviornment. Patients having large APEX tumors may do much better with radiation. Historically surgery has yeilded 30% positive margins. Today's surgery are more in the low 20% range.
In radiation failures there could be doe to an uneven dose that left dead spots or the dose was not high enough to kill all of the PC. Margins in radiation are usually not a problem in that the margins are usually 10-15 mm and should get most extra capsular extensions.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.