Recurrent Prostate Cancer Psa Rising

My Father has recurrent prostate cancer, First diagnosed in 1987, Had prostate removed immediately, was a gleason score of 5. went four years and PSA begin to rise.  Started lupon shots but side affects were to much.  Had a orchiectomy done and PSA stayed below four for 10 years.  PSA began to rise again and started on hormone therapy. has been on nilutamide for two years with PSA staying below 5.  PSA started rising again six months ago.  Still taking Nilutamide but last PSA reading was 8.5.  Had a PET scan done two months ago and came back clean.  He will go have a bone density test done in November and will see the doctor a week later for another PSA reading.  I believe the Hormone therapy has played out.  Does anyone recommend a DR at MD Anderson in Houston that is familiar with this kind of Situation?  We live in San Antonio and currently go to Cancer therapy and research center in San Antonio.  I think more can be done for him if we go to MD Anderson.  Any other sugestions for my Father without going out of the country.  He has been drinking pomegranite Juice every day for two years now and is in perfect health except for the cancer and slight anemic.  He is 73 years old.  Thank you for any responses.

John P  

My father has had  bone and cat scan every year for the last three years and everything has been negative.  I insisted that he have a PET scan because his prior scans were negative.  Why would his PSA still rise if there is no cancer present so far.  Do you think MD Anderson in Houston could find why his PSA is rising?

John P 

Sometimes the tumor is small volume or diffuse.  If he is still healthy I would do the biopsy of the prostate bed.  If not then maybe you just watch it rise and treat when it does appear or is visible.  PET may not in this case be revealing, CT has problems differentiating tumor from soft tissue/scarring.  You either treat and see what the PSA does or you wait till something shows.  On the good side is he has a low grade tumor so it may take a long time to show and won't be symptomatic.  On the downside it may not be salvageable at that time.  These are hard decisions to make and are multifactoral.  Only the patient can decide to go all out or wait.