We likely will not find a total definitive conclusion in trying to answer this question, although there is 30 year old evidence that it supposedly makes no difference as to when you start which is a continuing controversy onto today and not totally confirmed or defined is my contention. In Dr. Walsh's book, he is fair enough to show where the old evidence comes from and that it very well is or could be valid still (2001 Book), he also is
open minded enough to point out the flaws in a number of those abstracts that are quoted by other doctors and used by them still. Which many will not admit to seeing any possible flaws or be
open enough to say....not enough is totally known at todays juncture. Which I would say the premier oncologist docs would say not enough total evidence known, because of what they do in various protocols, even they are saying they have found surprizes in recent patient histories and newer results, (Dr. Myers comes to mind on recent patient of his). John T you mention starting earlier on the PCa ADPCa population, that makes sense and might even prove to righteous, I am pointing out what mainstream is using as their basis.
We also have to remember alot of this data and conclusionary prior evidence is based upon older abstracts, testings and such. Bigger still these findings are usually based upon patients using standard drug protocols, like LHRH or casodex or maybe a combos. No to many are done on alternative drugs that are found also effective(estrogenics, keto and some others). Add to this, what about mulitple protocols that seem to help a number of patients live longer or beat some of the odds of survival duration(s). Also, add the additions of the latest drugs (Leukine, Abiraterone, MDX3100, etc.) or chemo's (Cabitzatexal) or Provenge or DCVax the new vaccines(could change alot of duration findings). It could be a decade or more before we have the overall picture on patients with 8-10 yrs.+ history and thus new abstracts, that I would bet show better results than in the past. Most of the clinical trial data found in these newer drugs show improvement data comparitively, already just in only trials useage (usually those people have the nastier stats to prove the drug is worthy for useage, like Provenge...imagine this taken in patients with moderate PCa scenarios...could be astounding..maybe see them get 10 yrs.+ before progression??) Some of those high risk patients got 3 yrs. of real significance, not just 3-4 months.
Looking at patient histories like at yananow.net and other cases we can witness....results vary alot...some cases have defied this idea of you have a certain time frame and makes no difference. Patients have died eventually from PCa, but their journey and duration defied the norms...a good example at Yananow is Trueman Seamans with Dx psa of 4212 and some bad stats, on average a patient as such might live 2-4 yrs. or even less. He lived 10 years with some good Oncologists on his case and a few different protocols. Is this an anomalie, well when looking at other patients that leading onco docs are working with, seems to support it is not a total anomalie. Dr. Fred Lee's story is one of most facinating histories I have seen in a contiuing 27 yrs. battle, 25 yrs. of it with (mets) according to Dr. Bob B. his friend urologist said at a prostate group seminar...known mets and perhaps the longest living known mets patient. (I also asked him again to repeat what he said to make sure of his quote....mind blowing in PCa circles). His story I posted before it is on the internet google it the link starts with (www.rochesterurology...)
I could make this a longer drawn out discussion and others herein can add there findings or known information things they have collected and summarized and such. I can't say I know for certain any easy answer on this, I try to assume a more positive mindset (believe it or not) but always a skeptic and question plenty and especially question mainstream as to when they have definitivy in anything in PCa...the usual findings is plenty of exceptions, unknowns and variables. So, when mainstream hangs it evidence on 30 year old findings and miss things in abstracts and has not even touched on the newer protocols or combo protocols or even like to acknowledge those 'crazy' leading Onco-docs as maybe knowing the biology better than they do. Yeah I gotta question it all, lots of money being made by everbody (usually)...perhaps this is just the way they all like it.
It gets to be more like Ripley's Believe it or Not in some of these patient scenarios. It seems some evidence exists of anectdotal remission or cure...rarer than rarer..but even in Walsh's book he does not rule it out when talking about hormone therapies and he is more than fairminded on using DES than many doctors out there...which helps me believe he is a real fair and objective type guy, even though not an oncologist. Alot of urologists apparently disagree with Dr. Walsh (on some matters) as do some oncologists and probably some radiologists. No 'Easy Button' for patients to press in PCa. I like the term Twilight Zone where it is hard for people to know are you living in a real world or a fictional place...this limbo land of HT...is a good analogy...I hope most of you can avoid this visit, but you could do it even if you think you cannot. So what does the sign post up ahead...say! Hopefully you have non-dectable psa's along your path.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35 normal, ct and bone scans appearing clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off for 1 yr., controlled so well, resumed, using intermittently, pleased with results