Where does prostate cancer "come back" after surgery?

At a patients meeting this evening, they were talking about radiating the bed. The prostate bed. Anyone have handy the percentage of re occurence that is located there? It's not 100 I know that, and I think it is not more than 66%. But I'd like a citation.

[pjoshea13]

No citation from me.

A clue is how close the margins are. Pathology might not report penetration, but a 1 mm margin in my case had my radiologist nodding.

I did not want radiation & I was looking for the same answer as you.

In the end, until there is a scan that lights up every PCa cell, it's guesswork.

RP is as aggressive as treatment can be. The logical continuation after failure is salvage radiation [SR]. Why suffer the morbidity of RP but balk at SR. How bad do the odds have to be to refuse treatment?

-Patrick

[Shooter1]

Mine didn't have to "come back". RP and PSA jumped. Rare and not good.. Seems all neural and veinous channels out of prostate area were hot. (Gleason 9/10). Nice spider web into all areas around prostate and removed lymph nodes. Even tissue samples not associated with them showed channels through them.. No real target for radiation.. not concentrated anywhere. Peripheral damage was going to outweigh any benefits. If you can get the bed shot and it can help, go for it. I'm just Chemo and ADT drugs at this pt. 7 cycles into taxotere and already on Xtandi acct. rise in PSA while on Chemo. and Lupron. Wish you the best.. lots of good info and great folks on this site...

Doug

[Hidden in reply to Shooter1]

Interesting. I have heard that the prostate cells can be scattered like dust. Obviously that would call for a more widespread, possibly systemic approach, whereas if they are concentrated in a few lymph nodes that can be identified, a localized approach makes better sense for the next treatment.

[Break60]

I’ve read that on average it’s like 30% but for high risk guys like you and me it’s probably much higher. You’ve received good treatment. Obviously the bed is the most likely first place then pelvic lymph nodes and then ? Mine showed up in femur after bed and nodes.

[Hidden]

I myself have not had any treatment to the primary. Someone at a patients group talked about radiating the bed, when the PSA begins to go up after RP. But without knowing where the prostate cells were that were causing the rise in PSA. Of course they could be in the "bed", but they could be one or two nodes, or even a bone met in some far off bone - the sternum is not impossible.

That's why I asked if anyone had the percentages handy. Somebody has them.

[Hidden in reply to Hidden]

Here is something, although more to the point that localized therapy is unproven.

prostatecancerinfolink.net/...

But if that is taken as the current guidance, it hardly argues for confidence in radiating the "bed".

[Emak1]

Going through this right now. Had RP in Aug 2016, Pathology was clear, Gleason 3+4 T2c. 16 month later I confirmed re-occurance, last PSA prior to ADT was 0.27. Downside is doubling time quick around 3 months. Upside is early (0.2-0.5) to very early (less than 0.2) detection.

Did tons of research, the MSKCC namogram puts me at 68% for a 6+ yr remission. This is with SRT and ADT (currently on 6 month on firmagon). Most other namograms have me at 70% or even higher. But if I dig into other studies, high doubling time and under 3 yr re-occurance has downsides with lower numbers in the 40% range of long term remission.

Scans to prostate bed and full body were clear (these were done around 0.2). Was really hoping for a dot or something in the bed. My oncologist said she expected this. Her opinion is also 65-70% it is in the bed.

So yes we are shooting in the dark.

But my thought is, I went through the RP and came back with little side effects, AND this is the last solid chance of curative/long term remission. In my mind it is a coin flip. I am going to sloan kettering, so the folks doing the aiming and radiation firing are the best in the business. Scary stuff, but got to take the chance. Even if I could get 2-3 yrs of remission without treatment, I am hopeful of treatment progression and tackle it again at that time.