Posted Yesterday 5:04 PM (GMT -7)
Thank you for your replies, comments and concerns. I appreciate the feedback and support. Truly great folks here!
David: as always, you make very valid points - even more so if you factor in my potential longevity - my father recently passed away at 97 (not from PCa) and my mother is still healthy at 80. To answer your question, I guess I am waiting for an unequivocally rising PSA signifying a malignancy as opposed to a stabilized PSA signifying a possible benign condition. Even though the latest definition of BCR seems to be established at 0.2, this does not necessarily dictate that a reading of 0.2, or higher, is a malignancy. I believe it is important to consider the total PSA and the PSADT collectively. In calculating the PSADT, there are differing opinions on which data (PSA cutoff points) to enter into the calculation. If I use the calculator provided by MSKCC and enter only the values > 0.1 as instructed in the calculator, my PSADT is approximately 36 months. If I include the value of 0.1, then it is approximately 15 months. In my decision to initiate SRT, the negative surgical margin status also plays an important role as it decreases the odds of success.
LV-TX: we do have similar stats, but there are at least three additional fundamental differences that I can identify: 1) you had positive margins, whereas mine were negative, 2) using 0.2 as the BCR marker, you experienced BCR at approximately 18 months post surgery, mine was about 50 months and, 3) your PSADT is shorter than mine. To answer your questions, both the radiation oncologist at Yale and my urologist were supportive of my decision to hold off until more data is collected. The rad oncologist said “we do not have enough significant data on guys like you” and, regarding whether to begin SRT, he said, “it’s a crapshoot with your stats”. He also added, “your PSA is very low and your PSADT is very long, both good prognostic factors”. When asked what he considered the absolute PSA cutoff point after which SRT could no longer be a potential cure, he said “about 1.5”. Personally, I would not wait until 1.5 and I also know that SRT is a “crapshoot” in many (if not most) cases. I just want to ensure that, if and when I start SRT, it is absolutely necessary.