Thanks for explaining. OK, I'd certainly want a confirming PSA, but let's say that the salvage radiation didn't get it all. What are his options now? He has three that I can see:1) Begin hormone therapy immediately.
This would certainly control his cancer for now, but at the expense of his quality of life. There is no evidence that starting hormone therapy sooner has any survival benefit over waiting, and it may
drive earlier resistance to hormone therapy.2) Wait to begin hormone therapy.
Many oncologists advocate waiting until mets are detected, or there are symptoms, or the PSADT becomes rapid. This affords a quality of life advantage, and there is no evidence it harms survival. However, it is hard to "do nothing," and for some, the anxiety is unbearable.3) Wait until PSA rises to over 2.0 ng/ml and get a PET scan then
Mets generally can't be detected if the PSA is under 2 or it is not rapidly rising. Bone scans generally can't detect mets if the PSA is under 10. Some of the newer PET scans can detect mets when the PSA reaches 2. Mayo offers the C11 Choline PET/CT, but check with your insurance first. There are several new PET tracers that may be a lot more sensitive that are in clinical trials, and may be free of charge.
There is a theory that such mets, if there are very few of them, can be treated with a few zaps of SBRT, which may halt progression for a while. It is not likely to be curative, but it may add to survival and quality of life - no one knows for sure. But the SBRT is not at all toxic, so it's hard to argue against this route.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 7 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA
•PSA now: 0.5
No lasting urinary, rectal or sexual side effects, except loss of ejaculate