Wanted to share for thoughts and comments the advice of a retired chemist who is well recognized, long time activist in PCa matters.
He wrote: I can understand not reacting quickly to a PSA elevation, but waiting for a PSA of 10 makes no sense. Usually salvage treatments work best when the tumor load is at the lowest point. This is because mutations accumulate with time and these tend to cause treatment resistance.
More so when the biopsy samples contain Gleason Grade 4 cancer. That said, the typical systemic treatment is hormone suppression. This is a treatment that when done early can improve survival.
You can try hormonal suppression with the objective of going intermittent after a period of 9 to 13 months based on your PSA response to treatment. The faster the reduction of PSA the sooner you could decide to go intermittent. about the drugs used:
1. Trelstar. This is a LHRH agonist injection that will reduce testosterone to castrate level. Try the 28 day depot injection first for two or three cycles. Switch to a 84 day injection thereafter.
2. Casodex. This is an antiandrogen to be taken at least two weeks before the first Trelstar injection. Continue taking this antiandrogen for at least one month.
3. Avodart. This is a 5-alpha reductase inhibitor. It prevents the formation of dihydrotestosterone which is the most potent androgen. This should be taken all the time along with Trelstar.
Age 73. Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies.
Four biopsies. Two positive and two negative. Positive reflects involvement in one area (Left Apex 3%). Gleason 3+4=7, T1c, negative DRE. Received 40 doses of IMRT delivered by Fox Chase affiliate 05/05. PSA 10.5 before IMRT - drop to 1.8 - now 3.1