As you might recall from my posts, I have PC with a relatively poor pathology (G 4+3, PNI, very small focal positive margin of <0.5mm, and ecp. SMI and LNI are negative). I had the surgery and after some discussion I am following the Ford doctors' recommendations/protocol which is to monitor post-op PSA and go to SRT if needed (the alternative was to do adjunct radiation). My last pre-surgery PSA was 4.19.
OK, my PSA is creeping up, unfortunately. It has gone in 3-month intervals from .01 to 0.02 to 0.06. My next PSA is scheduled for 12/21 but I will probably delay it until just before my next Ford appointment, set for 1/7/11. (No use ruining the holiday season).
But, I have also scheduled a 11/1 appointment with Dr. Hussein, supposedly a very good medical oncologist specializing in PC, at Umich.
Basically, I want to hook up with a good medical oncologist if things go south. So, my question to this group is: what questions should I be asking Dr. Hussein? So far, I want to ask:
1) How do I know if the barn door is open? In other words, is there any way to determine if the PC has gone systemic, which would eliminate the need for SRT?
2) Does it make any sense to do any kind of scans? If the probability of anything showing up is say 4%, does it make sense to subject myself to those tests?
3) Does it make sense to get on HT before SRT? If so, right now? Or under what conditions?
4) I am assuming that SRT is the next step if my PSA rises. If so, what PSA level would trigger that next step?
5) Supplemett/diet recommendations. I read a lot of contradictory reports (except for D-3). Opinions?
OK, your input. Other questions?
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06