He’s been treating patients with early stage prostate cancer for more than 20 years. So he knows his stuff!
Arnon Krongrad, MD is a highly experienced prostate cancer surgeon and former prostate cancer researcher. He practices at The Krongrad Institute in Aventura, Florida, and specializes
in minimally invasive prostate surgery.
Dr. Krongrad will answer questions when he is able to do so, but he cannot guarantee to answer every question that is posted.
Dr. Krongrad is not your doctor and he cannot give you medical advice unless you become his patient. You should always talk to your doctor about your condition and what you should do.
You may post your question for Dr. Krongrad using the comments/reply box below. Questions and answers are retained on this page for approximately 60-90 days from the time they are originally posted.
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Aloha Dr. Arnon,
I know that my prostate cancer will return. (G = 8 & 9; 12 of 12 cores, 4 to 70%; PSA = 8 and 6 months later PSA = 14; started ADT 5/07; EBRT/IMRT 9/07 and 10/07; last shot 4/08; PSA = 0.72 on 01/09; testosterone 1.7.)
My doc says he wants to start ADT again when PSA is 1 to 2. The side effects of ADT were and are still very bad: continuous pain at shot sites, teeth worn down, weak split nails. I do not want ADT again unless there is a clear indication of PCa. Finding the PCa does not seem to be achievable or within the realm of modern medicine. Is this correct?
As I understand it, we cannot detect the returning PCa until it is sufficiently large to be seen on a scan. So there is no location that could be determined for biopsy. So, it is ADT again or wait until the PCa is detectable.
I do not like this position.
Joe
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Aloha back to you, Joe, and mahalo for writing.
I don’t like the limitations of our technology either. You are quite right that there are limits on what we can know. The PSA is sure sensitive and it does pick up recurrence before a CT, bone scan, or other test can validate it and this is its problem: it does not tell us where the recurrence is and does not tell us about options for localized treatments such as radiation. Which leaves us with generalized approaches, such as the hormone treatments that you do not like.
If you do not go on with the recommendation for ADT, be sure to stay in close contact with your doctor and to stay compliant with protocols for surveillance.
Arnon
Biochemical recurrence after 5 years to 0.56. Doctor 1 recommends waiting for radiation. Doctor 2 says do radiation now. Please give your opinion.What could the side effects be? Thank you.
******
Dear Gerry
I assume you are talking about biochemical recurrence after radical prostatectomy. Not knowing your medical and social status I am somewhat reluctant to give an opinion. There is surely some risk with pelvic radiation, including of urinary urgency, bleeding, pain on defecation, and fatigue. Depending upon your medical situation, age, and such, there may be reasons to monitor and not treat. On the other hand, there may be every reason to treat now, not later. Again, I would have to know your status to render an opinion. Please discuss your situation in light of your overall condition.
Arnon
Hi Arnon,
I’m 60, caucasian, with no family history of prostate cancer. However, in one year, my PSA went from 3.0 to 5.4. I read about PSA velocity of more than 2.0 being an indicator of aggressive cancer, but was confused by the arguments. I asked my urologist if there was any way to determine aggressiveness from PSA scores and he said no. He then told me that a rapid rise in PSA was probably a sign that it was not caused by cancer because cancer-caused PSA velocity is slower. Since this contradicted what I read, I’m even more confused. Any thoughts? Thanks.
**************
Dear Thomas:
1) PSA can rise and fall for many reasons including cancer and infection.
2) The rate of rise is suggestive of cause. Fast rise (and fast fall) is consistent with infection, trauma, cystoscopy.
3) It is not at all clear that the risk of a positive biopsy as assessed from the absolute serum PSA is in any way moderated by calculation of velocity. Here is one entry on the subject.
4) With a PSA of 5.4 ng/ml a man generally has a 25% risk of a positive biopsy (showing unknown amount and grade of cancer). The question is if given everything else in your life (smoking, obesity, diabetes) you want to know if you have prostate cancer. If the answer is yes, then a biopsy is useful.
Hello Dr. Krongrad,
Thank you reviewing my question. Basically my question is regarding what you think is the best treatment choice for my prostate cancer and if I should get a second opinion. I was diagnosed in January of 2009 with one core out of the ten showing 55% cancer. My Gleason score is 3 + 3 and stage is T1c. I will be 60 in July of 2009. My urologist is recommending robotic surgery to have the prostate removed. He will also attempt to spare the nerve bundles. Since I have not had a second opinion except for the meeting with a radiologic oncologist and a consult with my family physician, I am having a hard time making a decision and having a problem communicating my questions with my surgeon. He is somewhat dismissive of my questions and I walk away without clear answers. Please advise on how I should proceed. Any advice would be much appreciated.
David:
Three issues:
1) Which treatment? This has to do with competing risk analysis. Without knowing your health nobody can really advise you on even the simplest question of should you be treated. This recommendation cannot be made by public blog but can be made by private consultation. Which leads to …
2) Communication. You cannot communicate with your surgeon. This is preop. What happens post-op? Would you want to be not communicating with your surgeon post op?
3) Doctor selection. There are many variables in selecting a doctor. If it’s a surgeon, as you are discussing, then here are my thoughts on how to pick one: http://prostatecancerinfolink.net/tips-tools/pick-surgeon/
You keep asking about a second opinion. Is this in itself not a reason to get one? Why would you not?
Dr. Krongrad:
I am wondering if you have had any patients present with pleural mets and a solitary lung lesion who have not had any bone metastases?
I am 12 years post seed implant in Seattle and external beam radiation in Denver. Had Gleason 6, T2c lesion when treated at age 56. Two bone scans are negative but a PET scan found the LLL lesion. Surgeon went in to remove it and found my pleura covered with small mets, all prostate cancer.
Have just started ADT but trying to find if others have seen this presentation since none of my care providers have seen it. My PSAs were all <0.1 for 8 years post-treatment but began a slow rise. Just hit 10 at the time of my lung surgery but doubling time has decreased to 3-4 months now.
Dear Bob,
I am sorry to hear about your situation. It is never fun being the only one of your kind and it appears that this is your situation. No, I have not seen this scenario, though prostate cancer can in fact go anywhere.
How do they know it’s prostate cancer? After all, there is evidence of PSA production in lung tissue. Is it at all possibly a lung cancer?
Arnon
Dear Dr. Krongrad:
I’m 76 years and have just been diagnosed with prostate cancer. I have a 6.7 PSA, 3 + 4 = 7 Gleason score and a stage ll classification cancer. The cancer is localized in the prostate. I’m considering Cyberknife therapy. What is your opinion? Thanks in advance for your response.
Best wishes,
Ron
_____
Dear Ron,
First of all I would really like to know much more about your general health. In other words, the first question is not how to treat but if to treat. If you are in failing health it may be that simple surveillance is a right choice. You get my point: the question should first be answered in a broader context.
Secondly, assuming the choice is to treat, the question next is how to treat. Radiation is one option in early stage prostate cancer. If you are a clinical stage II (I am assuming cT2 or cT1; you can confirm with your urologist), then this might be very reasonable. As to which type of radiation, I would defer to the radiation oncologists. Among the critical considerations is not only which approach but who should treat you. Remember that radiation success is partly dependent on the doctor doing the treating. To this end you may wish to read How to Pick a Radiation Oncologist. You may also find interest in some of the posts relating to cyberknife. Here is one example.
Arnon
Dr. Arnon:
Does the prostate gland ever actually heal itself with time from the impact of the core needle track where the tissue has been removed in a prostate biopsy? From what I have seen on the internet the needle track never appears to heal itself but rather remains as a needle track with varying levels of cell necrosis that never repairs or resolves itself with time. What are the currently known long-term ramifications of this on the organ’s ability to function.
Brady
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Dear Brady,
Two separate questions.
1) The prostate has blood supply and like all organs when healthy it can heal. So a traumatic injury which naturally causes some cell necrosis is soon overcome with normal scar formation.
2) The prostate’s function is a bit of a mystery in that while we know what it does — it makes part of the semen — we do not know if it is necessary. So two sub-answers: a) we know that biopsy does not interfere with semen production and b) we don’t know that even if it did it would have any clinical meaning.
Arnon
Arnon,
Here is a not-so-obvious case on which your opinion will be appreciated. A healthy and active 60-year-old patient has PSA 6, T1c, Gleason 7. Eight of 12 biopsy cores have cancer. The Partin tables predict about 50% probability that cancer may be in the surrounding tissue but CT and bone scan show no metastasis.
What would be the preferred treatment options and why? If surgery is preferred, can Da Vinci match traditional open surgery to eradicate cancer the first time?
Silvia
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Dear Silvia,
Thank you for writing. The situation you present is actually very common. Let’s go through some issues:
1) There is absolutely no surprise in the CT and bone scan findings. First of all, the nomograms relate largely to micro extension, which CT and bone scan cannot pick up even if they are there. Secondly, there is a 50% probability that even micro extension is not present. No surprise at all.
2) The treatment preference is largely set by the patient. In other words, we do not have randomized comparisons of such standard treatments as radiation and surgery by which to provide a scientific framework for a decision. The patient really should spend time learning about the treatments, including their standard applications, logistics, and side effects. He should meet doctors who could give them to him at a high level of ability.
3) Da Vinci is but a remote controlled sewing machine. Can it match a directly held scalpel? Sure. In my hands Da Vinci patients do as well as laparoscopy-no-da-vinci patients who do as well as open surgery patients, though with less bleeding and pain. The key question is not tools but the surgeon who’s wielding them. Ask yourself: is it the club or the Tiger Woods that wins the matches? Focus on the surgeon, not on the gizmo. Do not let go of this question: who is the surgeon?
Arnon
Dr Arnon:
If you are scheduled to have a prostate removal or part of it [that contains] cancerous cells, and after the MRI scan they have prolonged the operation, is this because the cancer was found in other areas too?
Dear Nick,
I have no way to know why the operation was postponed based upon what you are presenting. Maybe your surgeon can explain this to you. Ask him.
Arnon
My husband had an elevated PSA at age 49. The urologist recommended Flomax and a biopsy. The biopsy was done in the office without any discomfort. 24 hours later he developed a high fever and was admitted with sepsis and the bug was E. coli. After 5 days of tobramycin, he was discharged with Flomax, Avodart, and 1500 mg Cipro for 10 days. After finishing the Cipro, he was getting his strength back. On day 21 out from the biopsy, he developed a fever again. Back to the urologist and he has a major UTI. Outpatient IV tobramycin for 10 days along with Levaquin 500 mg. Cultures came back with sepsis again and UTI all with the same E. coli bug.
We are early in this process but we are now hearing 90 days of Levaquin followed by 90 days of Cipro. Should we be seeking a second opinion at this stage of his relapse? And by the way, there was no cancer in any of the 12 samples. I’m pretty sure this isn’t a normal recovery from a needle biopsy. What could have happened?
Dear Katidyd,
Thank you for writing.
First of all, the prostate is a dirty organ. It is a repository of bacteria and viruses, for which there is usually no pre-operative evidence (click here).
Secondly, bacteremia and sepsis are known complications of prostate biopsy. For a look at another and rather dramatic case you can click here.
You are surely within your rights to seek a second opinion. However, what you are describing is a situation known to any doctor who does biopsies. It should also be something that has a relatively straightforward solution.
Arnon
Hi. I need to understand the PSA levels. My brother is 65 years old and has been told that he has prostate cancer. His PSA level is 10. What does that mean?
Dear Rose,
I am sorry for the delay.
PSA is prostate-specific antigen, a protein made in the prostate. PSA “leaks” into the blood stream, but more so with some conditions, including cancer. The higher the blood PSA the more likely it is the man has prostate cancer. For a man known to have prostate cancer, the higher the blood PSA level the more advanced the cancer is likely to be.
These are very general rules. No PSA level can specifically say if a man has prostate cancer or if his cancer is at a specific stage. For this, one needs additional tests, including biopsy (it sounds like your brother has already had one) and scans of various sorts.
A PSA of 10 ng/ml cannot be interpreted in a vacuum. To known its meaning to your brother a lot more information is required: his age, his health, the cancer grade, the cancer stage, and more.
Thank you.
Arnon
I am 62 years of age. I had a radical prostatectomy in September 2005. For the last 3 years my PSA has risen. In February of this year it was 0.6. I had it tested again on May 14th. My PSA has gone down to 0.4. Can you explain this?
John,
PSA fluctuations are common. For this reason, we tend to look at patterns in a post-op situation. A steady rise over 3 years suggests one thing, and a temporary quick rise and fall another. You should review your pattern with your surgeon and see where to go next.
Arnon
My husband is 43. He’s had two bouts of prostatitis that have seemed to respond to antibiotics. He had two PSAs done in January. The first was 5.8. They didn’t tell him not to ejaculate within 24 hours before the first draw, so he had a second done a few days later that came back w/ a PSA of 6.1 and a fPSA of 12%. Based on that they did a biopsy that showed 11 clean cores and one core with ASAP cells, labeled ’suspicious’, foci of asap.
We were advised to wait 3 months to have another PSA, and depending on those results another biopsy immediately or in another 3 months. We went ahead and had another PSA drawn at 6 weeks, which came back lower, 4.63 (good news), but the fPSA was also alarmingly lower, 9% (though the PSA/fPSA came down EXACTLY the same percentage). Does this mean the fPSA decline is explained by a change in volume of the prostate rather than an increase in bound PSA — making the decrease in fPSA a statistical artefact rather than a true indicator of increased risk?
Other history, his father was treated for PC at age 65 (and seems fine today at age 76) and his mother, her twin, his first cousin, maternal grandmother & great grandmother all had breast cancer. On the other hand, he’s had four normal DRE’s in the past 3 years.
Here’s my question: Are we moving fast enough to get a diagnosis that would allow a cure? Nothing I’ve read is reassuring that we can be sure that (a) he doesn’t have PC today or (b) that we can dismiss the possibility of it being a high grade, aggressive cancer. What do you think of the PCA3 or PCA3Plus tests as diagnostic tools? Are there other diagnostic tools we should be pursuing?
My worst fear is that his urologist knows that in a guy so young, it’s inevitable that it’s a high grade, lethal cancer and that he’s delaying treatment to give us a little more time before we enter the phase where he’s meaningfully debilitated by treatment on the way to dying before the age of 50. My more reasonable fear is that we’re going to screw around and let the cancer extend beyond the prostate, making the treatment much more invasive, the recovery much less complete, and the possibility that he’ll still die from PC much, much younger than he should much, much higher!
Why would we be advised to go so slow when the risks are so very, very, very high? If 30k men a year die of prostate cancer, clearly the existing protocol isn’t getting everything right.
*******
Tracy
You have very correctly assessed that there is uncertainty at every step and that our tools are imperfect. What you have also assessed is that your young husband’s family history of prostate and breast cancer along with his PSA and atypical small acinar proliferation (ASAP) have put him at a very real risk of having prostate cancer. That assessment is moderated by two more facts: 1) it is very possible that he does not have prostate cancer and that 2) if he does have prostate cancer it is in an early stage.
In such circumstances as your husband’s I have at times advised my patients to repeat the biopsy. This is a relative recommendation, not absolute. On the one hand is the idea that he has an approximate risk of 50% or so of a positive biopsy in the next year. On the other is that he has an approximate chance of 50% of a negative biopsy in the next year. If he is not only young but also very healthy then the argument for a biopsy sooner rather than later becomes more pronounced. This is something he can discuss with his doctor.
Arnon
Dr Arnon:
I had my cancerous prostate removed in 2005. After the operation my PSA flat-lined at 0.04 and stayed that way for 1 year, and then the PSA climbed to 0.15. I was given 33 radiation treatments and the PSA returned to 0.04 and stayed there for 9 months. At the next 6 month PSA check it had gone back up to 0.07, and 3 months later the PSA was 0.09. I don’t know how long I should go through the “wait and see” phase or at what level the PSA should go to before I get more treatments. I don’t even know what type of treatment I will get, but suspect it will be hormone therapy. I am 72 and have additional heart problems. Thank you for any information you can give me.
Thank you
James Frush
Hi James,
Thank you for writing.
A PSA is a blood test and not a disease. So we really do have to look at the broader perspective you invoke. To make any decision you really have to involve your entire medical team, including your cardiologist, because any decision for active treatment can lead to potentially important side effects. Hormone treatment, as one example, can cause mood dysfunction, lethargy, and bone loss. You’ll want to discuss these with your cardiologist before you risk them.
I would also suggest a diagnostic consideration. For example, a bone scan. This is so if you have hormone treatment (to be sure your’re not risking “flare” in teh presence of a bone metastasis) and if you are not having hormone treatment (to be sure you’re not under-treating a bone metastasis). In any event, something to discuss with your medical team.
Arnon
Every year I have a Vantas implant. After my last blood work was reviewed my PCP mentioned I wouldn’t need to replace the Vantas due to a near zero PSA level. Is this possible without risk?
Tom,
You raise the key question: what is the risk of going off treatment? The answer depends partly on the need for treatment (a reflection of your Gleason score, general health, etc) and the likelihood that you have achieved permanent suppression (which can happen, through usually after more than a year of active treatment). I would encourage you to review these issues with your medical team
Arnon
Dr. Krongrad,
I recently heard the term, “ultra-PSA” in reference to a more refined(?) test than the standard PSA. What is this, please?
Also, please enlighten me on EPCA-2 levels??
My husband had robotic surgery April 14th. His first post-op PSA at 6 weeks, was “below 0.1″ His next PSA is scheduled in 3 months. I can supply all data from the surgical patholpgy report if needed.
Thank you,
Sincerely,
Judy
Hi Judy,
PSA is a protein measured in the blood. There are various assays with which to measure it. Some are more sensitive than others. Do we want maximal sensitivity? I ask because first of all PSA is produced by things other than prostate cancer, eg normal glands of Littre. To measure all PSA is to measure things that are distracting too. I also ask because all tests suffer from some limitations in specificity, such that all begin to pick up “background noise” at super-low levels. I have never really found any good use for ultra-sensitive PSA tests. They do tend to give patients something to obsess about but they really do not alter clinical decisions.
EPCA-2 is a new “marker” proposed to help distinguish malignant from benign prostate tissue. This is not a task your husband faces for the simple reason that he has been already diagnosed and treated for malignancy.
It’s good to hear about your husband’s PSA of <0.1 ng/ml. That is where you'd like to see it after treatment. And yes, it makes good sense to check it periodically with the input of his doctor.
You may want to join the social network, where many of these issues are reviewed on a regular basis.
Thank you.
Arnon
Dr. Krongrad:
My prostate cancer was diagnosed in 1992 and I had external beam radiation. My PSA stayed below 1.5 till around 2000 when it crept above 3.0 ng/ml and I was talked into seed implants. This lasted lasted till about 2005, then the PSA crept up again, and so I started getting Lupron shots and my PSA went to 0.3 and has been that way since. I’ve been off of Lupron for 7 months and the PSA is still OK at 0.3. My question is that I was told by my urologist there’s too much scarring from radiation to have my prostrate removed now! Is this a valid statement now at this time?
Thanks for any answer or comment.
Dear Ron:
You are talking about a salvage prostatectomy, a radical prostatectomy done after another primary treatment has failed.
Salvage operations are at times more difficult than “virgin” operations because the primary treatment — radiation, brachytherapy, cryotherapy — has had an effect on the surrounding tissue. As a consequence, patients are exposed to greater risk of such complications as incontinence and injury to adjacent organs such as the rectum.
There is no way to know precisely how much the primary treatment has effected changes that are problematic. I have done salvage prostatectomy after radiation, seeds, and cryotherapy and every case was different. One was just incredibly difficult.
In the setting of uncertainty regaring the precise effect of primary treatment we throw in the ambiguity of “too much.” When is risk “too much?” And who decides? And when is it not worth taking? Here too there are not black and white boundaries. One can tilt the balance — the patient is 80 y old and in poor health argues against taking surgical risk — but not set the balance. Only a patient fully informed of his overall health, his prostate cancer, and the risks of salvage and the risks of doing nothing can decide if the risk is “too much.”
My opinion.
Arnon
Bob,
Thank you for writing. I will answer your questions below. However, let me first clarify that I am not your son-in-law’s doctor. I am missing considerable specific detail and have not examined him. Accordingly, I will provide more or less generic structure within which perhaps you and he can begin to get answers relevant to his condition.
Arnon
My 45-year-old son-in-law has been diagnosed with T2a prostate cancer: his Gleason score is 6 and his PSA is 5.2. Our research leads him to believe that surgery is the appropriate form of treatment. However, our research leaves us wanting more specific/quantitative information about the prospects for particular side effects.
We are hopeful that someone familiar with available/credible databases can offer quantitative tendencies (e.g., frequencies or probabilities) for patients in his age group and with similar staging conditions. For example:
(1) Relative to sexual function: What is the likelihood for full recovery without drugs such as Cialis? What is the likelihood of full recovery with the aid of drugs such as Cialis?
“Sexual function” is a term covering a broad range of specific functions that include intimacy, libido, erection, ejaculation, fertility, and orgasm, each of which is to some extent separable from the rest. Prostate cancer surgery can affect them to varying degrees. For example, radical prostatectomy causes infertility in all cases but loss of orgasm in few if any cases.
Assuming you are asking most specifically about erectile function, I will further assume that you are asking about the likelihood that he will achieve erection adequate for penetration after surgery and when. To answer this question one really must back away from surgery and examine the broad medical and psychosocial context: age, illness (diabetes), smoking, obesity, depression, stress at work and home. All these color our assessments of expected current and future function.
There is a very specific question about surgery and its individual effect on erections. Here again we must back away for a moment and ask about the cancer. This is because it may or may not be sensible to save the nerves, which can in itself change the likehood of regaining erections. So if there is a lot of this Gleason 6 in this young man it may be risky to save one or both nerves. And conversely, of course, it may be smart to save one or both nerves. This question must then be placed into the general context above as we seek to assess the projections into his future.
(2) Relative to escalating PSA and the need for remedial treatment: What is the likelihood that the remedial treatment will involve radiation therapy? If the follow-up treatment involves radiation, what is the likelihood that such treatment will produce impotence in those who were fully potent before radiation therapy?
It is not clear that he will have escalating PSA. It is not known what the pathologist will find. Without these answers there is no way to assess if he will ever need additional treatment. As a rule, additional treatments may include radiation and hormones, both of which can reduce erectile function.
(3) Relative to incontinence: What is the likelihood of suffering mild-to-moderate incontinence? What is the likelihood of suffering more severe incontinence?
The likelihood of post-prostatectomy incontinence varies inversely with age: young men have less of a problem than old men. His overall risk of long-term incontinence would seem to be relatively low. Like most men he will almost surely have some short-term incontinence.
You have asked a number of excellent questions. Your son-in-law is lucky to have such insight on his team. As you go forward remember also that what you really want for him is a surgeon with a LOT of experience, focus, and sensitivity.
Arnon
Dr. Arnon:
I am a 70-year-old white male. I had my prostate removed 12 years ago, and for about 6 years after that my PSA stayed at <0.001. Since then it has been slowly climbing to 4.7 (from 2.7 six months ago).
I had a Prostascint scan 5 years ago and the results were negative. About 3 years ago I had a "PET" scan and it was also neg. Just last week (June 15 2009) I had another Prostascint scan and the results were: "Negative study for metastatic prostatic carcinoma" No abnormal uptake is noted.
I had an appointment with my urologist yesterday and asked him why the scan did not show anything when the rise in PSA indicates that something is going on? I also asked him what my options are and he said: (1) I could do nothing and just wait another year or so and have another scan, or (2) I could go to a radiation oncologist and receive radiation in the area where my prostate was.
He was concerned that if I did not try the radiation treatment to see if it would stop the rise in my PSA or lower it, then by the time we found out where the problem is with the previous type tests, the cancer may have metastisized to other areas and radiation would not longer be an option?
Please advise (or suggest or whatever you are allowed to do).
Thank you
Bill Stevens
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Dear Bill,
I apologize for the delayed response.
As a first step I would want to know about your general health. I know you were born 70 years ago but are you overweight, diabetic, smoker, epileptic, fit? I would want to know those to gauge your likely survival time independent of prostate cancer and to gauge your ability to tolerate radiation. If you are quite ill, then the argument against early adjuvant (additional) radiation is fairly strong.
Your PSA is on a slow course up. This argues that the likely site of recurrence is in the pelvis, as implied by your doctor. However, it is remotely possible that it is not. Thus, to move forward with radiation, if you do, is to take on the very small risk that it is a treatment that is mis-targeted. This relates to your question about the tests: They are not infinitely sensitive and cannot compete with the PSA blood test at detecting early recurrence. On this subject, I would consider a bone scan.
There are no absolute rules on when to start (if you start) adjuvant radiation. At 4.7 ng/ml you have hit many doctors’ threshold but I have seen patients go for many years with elevating PSA, no treatment, and no clinical sign fo recurrence. The precondition for observation is that there be observation, which means periodic testing with such tests as bone scan. The last thing you’d want to do if you are observing is miss a new metastasis in the cervical spine. The last thing you’d want to do is ignore a new back pain. etc.
Good luck. And please consider joining us also on the network.
Arnon
Dr. Krongrad:
My husband’s post-op robotic prostatectomy pathology report showed Gleason 4 + 3 = 7; surgical margins: positive, rt. posterior, 1 cm in linear length; extraprostatic extension: positive (rt. posterior, unilateral extensive); seminal vesicles: negative; 4 lymph nodes: negative; TNM pathological stage pT3a. First 6-week post-op PSA was < 0.1.
I understand there is debate as to whether radiotherapy should be instituted at this time. Next PSA due on September 1 (3 months after the initial PSA ). What is your opinion regarding radiotherapy and timing thereof?
Sincerely,
Judy Yoakum
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Judy, please see the answer to Bill that I just posted and the discussion on the network (click here).