OK, I keep hearing about these great docs who always think outside the box and try this and try that. (Strum, Myers, Stolz, etc.). Frankly, at some point this can be very useful as they do seem to keep their patients alive for a long time. In fact, it seems to be part science, part medicine, and yet part art. For example, when to (or whether to) try Leukine, or DES, or this or that. When to try chemo? Do it early?
So, with that preamble, here is my question.
There seems to be a generally accepted standard of care (this represents thinking within the box). Say we start with surgery (yes, I know there are other primary treatments, too). Surgery fails so we then do SRT. SRT fails and so the curative bullet is gone. So, we then try and turn this into a chronic long-term thing rather than "the end."
We then proceed to more standard treatment, to wit HT, probably Casodex too (my understanding is that the Casodex first for a week and then HT is added). Now, is this the point at which the treatments become an art? In short, what is ADT2 and/or ADT3 and is this still standard? Then there's the question of intermediate ADT. I assume this is done if everything works great for 2+ years and the testerone level is low?
Does the art really kick in when things become refractory (ie: HT starts to fail)? Or is there still a generally accepted tx. protocol?
I hope this rather long-winded question makes sense!
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. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!