OK, I am back from seeing Dr. Hussein today at Umich. It was a well-spent hour.
She is very nice, articulate, knowledgeable, and spent sufficient time with us.
First, she does recommend immediate radiation. We discussed it at length. Her reasoning does not pertain to my PSA scores; they pertain to my pathology. With my pathology, studies have shown adjuvent appears to work best. But, actually, that was my big discussion with the Ford doctors when I first got my pathology results. They recommended I wait since a large percentage of patients with my stats end up not needing it. Why subject myself to this treatment. Dr. Hussein could also see that viewpoint. She says with their adjuvent philosophy, they know they are overtreating people. She said that, for example, out of every 100 people treated, it might well be that only 30 really needed it. So, again, we have that grey area. While she recommends treatment solely on the basis of my pathology, she feels the PSA rise probably indicates activity, but, as she put it, "what am I to make of numbers below 0.1?" Basically, Umich (like Ford) really prefers the non-sensitive test. With their criteria, I would still be <0.1 (undetectable). In short, my reasons for deciding to wait haven't changed. She really did not push me to have SRT (it would be almost ART in my case).
Regarding how do we know if I have a very aggressive PC, we don't know. I probably do not (given a G4+3). It was stated that whoever discovers a definitive test for that might get a Nobel Prize in medicine. That's still one of the unsolved problems with PC.
As far as doing any scans: not at this time.
AS far as doing HT prior to or along with SRT: they don't recommend that.
As far as supplements: most of it is BS put forth by charlatans (this is my interpretation of her comments, which were much more refined!). There is NO specific supplement they recommend. I can get what I need by eating a good heart healthy diet. (Vegan not necessary)
Since I am still sticking with my original choice of SRT, I asked what PSA score will trigger it. She was really not definitive about that. In fact, I was amazed: she said their radiation oncologists use 0.30 as the trigger point. She did seem to indicate this was a very grey area without much agreement.
Wednesday is my off-campus day. I intend to spend part of it searching for some cruises and maybe even finalizing an itinerary!
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