Quote:
Originally Posted by mastodons
My father had a prostatectomy in 1991. His psa then was 41.
He said he had an aggressive cancer then with a score of 9 but
I never saw the documentation so I don't know what this score is.
His psa now is 14. A urologist checked his bladder with a scope
and said he had no cancer but he wanted to check him again in
6 months.
Shouldn't they be doing more tests with a psa that high?
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The standard for determining that there is a recurrence after an RP is a PSA of .2; while that is not adopted everywhere, my understanding as a layman is that physicians would consider your dad to have recurring cancer.
That's not surprising as he had a case where the risk of the RP not curing the disease was high; the PSA alone would indicate that, according to the widely used Partin Tables that I and probably most of us have used to understand our chances for a cure. That score of "9" is probably a "Gleason Score," and, if so, that too indicates a high risk cancer according to those Partin tables.
I'm with Daff that a trip to a different doctor might be in order. I can't understand why the urologist would just check his bladder and then not worry about him for another six months. (Maybe the urologist has seen that he has a very slow and steady rise in PSA, or knows he has serious medical conditions that are much more threatening than prostate cancer?) A "medical oncologist" is the kind of doctor who frequently deals with recurring cancer. These doctors are usually good at managing hormonal blockade therapy, though it helps to find one who has handled a lot of prostate cancer patients. Radiation treatments might also still be timely if it can be estimated with confidence that the cancer has not spread beyond the range of radiation.
There are tests that can help determine that. One is the bone scan that many of us have had, including me. However, it takes a cancer that occupies at least ten percent of the area before it will show up as likely cancer on the bone scan. Another test is known as ProstaScint, or an improved version known as a fusion ProstaScint that combines a CT scan, and possibly also a PET scan, with the ProstaScint. I had the earlier version, and it is supposed to be quite reliable, detecting even fairly small tumors.
There is an emerging scan known as USPIO (Ultrasmall superparamagnetic iron oxide high resolution MRI), Combidex, or Sinerem, that is supposedly excellent at determining whether there is any cancer in lymph nodes throughout the body, but apparently no site in the US is expert with that scan. There is a site in the Netherlands that some doctors are recommending. (I'm a survivor with no enrolled medical education, but I've heard talks in which that doctor is recommended.)
As a layman I think your dad has at least one good piece of evidence going for him: he had his RP way back in 1991, and his PSA now is just 14. That makes me think his cancer that is recurring may not be that aggressive, but that is certainly a determination to be made by a medical professional. Therapies like hormonal blockade might be highly effective for him, even if radiation turns out not to be an option. (He might prefer blockade even if radiation is on the table.) Also, if the rise in PSA has been very steady and slow, he might be able to get away without doing anything major, depending on his age and other health challenges.
Take care and good luck to you and your dad,
Jim
Reminds me of the guy with a hammer that walked around thinking everything looked like a nail. 
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