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I was interested to see that you had calcification of the gland because that can affect PSA levels, and therefore the marginal increase in PSA levels might not be due to a recurrence at all, bearing in mind that PSA is NOT prostate cancer specific. I think you might look further into this aspect before making any decision regarding salvage that might not be necessary.
If you still feel that salvage is in your best interests, then your best bet is probably intermittent, low dose Androgen Deprivation Therapy (you refer to this as hormone therapy.) I say that because IF your PSA levels ARE related to PCa and not calcification or any other cause, then the likelihood is that the disease is, after six years, no longer contained in what is left of the gland or in it's immediate vicinty but is instead systemic. IF it is systemic then you need a systemic therapy not a local therapy.
Surgery is probably the least best of the salvage therapies available.
This is the first time I've read that the PSA could have risen due to calcification.
I don't have a copy of the latest biopsy which was done a year ago but was told the cancer came back along with the noticeable calcification. I will have to get a copy of the biopsy report to confirm it myself. I was also told it was localized so it made me a candidate for a clinical study of Hifu after failed EBRT which is on-going here in Canada. The Hifu specialist didn't seem overly concerned about the extent of the calcification present. But I'm not liking the recent studies out of Korea and elsewhere suggesting Hifu is not effective and carries high risk factors.
As I understand it, the calcification of the prostate can be associated with prostatitis and other gland problems, so it might not be that calcification raises PSA levels of itself, but that a raised PSA level is a bye-product of calcification, so to speak.
Although there are many and varied reports about how successful HIFU is, inclduing some men who have posted to Yana, my personal views is that I'd want a very well trained and experienced person to carry out any HIFU therapy on me.
Have you thought of Cryotherpay if you feel you do need some salvage therapy? I understand there are soe good Canadian institutions - see Why Cryotherapy by the late Colin Campbell
Following the failed radiation my urologist had sent me to a physician for cryotherapy. When I met him he said he is involved with Hifu now and said flat out that cryotherapy doesn't work and it was the "old" way.
I also found cryotherapy was even less successful than Hifu in some studies. Looking at both Hifu and Cryotherapy in terms of effectiveness and potential side effects doesn't give me any confidence considering my prior rectal injuries and prostate calcification.
Thanks for your suggestion but at the moment it looks like I'm caught between waiting and intermittent hormone therapy as I don't see any other viable alternatives.
