Low, But Rising PSA--Wait for Imaging or Act Now?

Thanks, all. Sibley is close to me, so that would work out well.
Jeff, this may be a stupid question, but why do I need a urologist, along with an RO and a GU oncologist?

@bikeman1
If you are considering surgery, you need a urologist. If you have any urological problems after being treated, you may need a urologist.

If you are not considered surgery then you don’t need the urologist managing anything.

@bikeman1 Dr Nagar is great - very knowledgeable and easy to talk to. I think you’ll like him.
Phil

Thanks guys--your help and support mean a lot!

I am on the immediate treatment team.
RP at 72; G 9 w/ EPE post-op.
PSA persistent at .19 90 days postop.
Referred directly to RO who recommended and initiated SRT w/ short term ADT to WPRT and pelvic lymph nodes.
Undetectable PSA following treatment for over 2 yrs.
All tx at Johns Hopkins.
I highly recommend JH and COEs.
Best wishes.

I am in the exact same situation and decided to act now. The question certainly isn't settled and Mayo is 2 months into a long term trial to determine whether waiting to see the cancer is as effective as early treatment with radiation and adt as indicated. So when you recur they present this option and ask if you want to postpone treatment. As you, I have idc , cribiform, early recurrence and a doubling time of three to five months. I personally do not feel comfortable waiting and am proceeding immediately with treatment.

The way I finally put this in perspective is that the Mayo trial is based on population based evidence that the majority of prostate cancer does not metasticize after initial treatment even with biochemical recurrence
Also, psma pet allows them to see things early to respond. However the earlier trials that show early treatment is the best and reduces mortality still exist. So when the stakes are raised by having IDC cribiform and early recurrence I believe you need to look at your personalized risk and risk factors rather than population based studies. It is not an easy question.

@heavyphil
"I have always found Dr Kwon’s approach unsettling. If standard SRT to the bed and nodes is to be frowned upon, why then do so many men - including myself - see a dramatic DROP in PSA levels after treatment?"

That is exactly what I told my husband the other day. So many studies show high advantage of having sRT and not only having it but with exact cut off number for great success (before PSA 0.5, and the BEST before 0.25 ) - so in what way waiting can be beneficial ?

If one listens carefully to presentation there is one place where doctor says that "for one third of patients there will be no benefit" - which means that for 2/3 it will ! I think that 66% of benefit outweighs 33% with no benefit. Missing about 30% chance of perhaps even being cured is not something that my husband and me are willing to gamble away, SA or not.

I was having a hard time reconciling the two conflicting sets of studies: one shows waiting is better, the other shows starting treatment sooner is better (and sooner than hitting .025 is best).
I think @dhasper made a really good point--what works from a public health perspective, may not work for me, with my particular characteristics. I couldn't find this when I looked at the "wait" studies, but I bet the people studied were mostly of "average" risk profiles--not people like me and @dhasper with higher risk profiles. And @suftohealth88 put it in better perspective: 2/3 of the men DID benefit from earlier intervention. I haven't yet consulted with my wife to get her perspective, but I am leaning strongly to starting soon. I also am lining up an appointment with Dr. Paller (thank you Jeff).
You all are great!

Just a short note to all who have contributed to this post.
I am facing recurrence and want to learn as much as possible. This list has been an enormous help to me. Thank you all so very much

Ed