-IMRT is at best a local treatment (tx) which might include (as in my case) lymph nodes and seminal vesicles.

If there were PCa cells beyond the tx field, they were of course not affected. A high Gleason is a sign that the PCa could be systemic. In such a case, IMRT will not be curative.

-Possibly a systemic tx such as ADT or chemotherapy. IF there is a recurrence. As to that, there is no evidence on the table. See infra. Before initiating any tx it is prudent to take steps to develop information on the biological status. Once that is known as well as possible, then and only then can a tx plan that is likely to produce optimum results be developed.

Here are staging marker tests (which really should be performed prior to primary tx but too often are not) that should provide such information:

(1) PAP, prostatic acid phosphatase: Since Bill still has a prostate, this will aid in determination of pathological stage and in predicting biochemical failure. Note that there is no evidence at this time that there is such a failure.

(2) CGA, chromogranin-A: a marker for small-cell or neuroendocrine PCa, which is different from and more risky than the usual adenocarcinoma that most of us have.

(3) CEA, carcino-embryonic antigen: a marker for micro-metastatic disease, which will not appear on any currently-used imaging test.

(4) NSE, neuron-specific enolase: a marker for neuroendocrine disease. See CEA.

All these are blood tests. They are recommended by one of the best, Stephen B. Strum, MD.

I wonder whether Bill has started ADT (androgen deprivation therapy), which, though a palliative tx, can kill androgen-dependent PCa cells. We hear much about the side effects (SEs) but very little about the methods of relieving such SEs.

There is much that can be done, but *first* Bill's clinical status must be determined.

Lastly, I earnestly recommend that the authoritative website of the Prostate Cancer Research Institute (PCRI) be consulted. It is a virtual encyclopedia of PCa information presented by some of the very best PCa specialists.

See http://prostate-cancer.org/index.html