You are at least making a start by asking for honest input. But there are some questions where you might get differing answers, such as when to start HT. Honestly, I would think that with high PSADT folks like you and I, you might as well start ASAP. Think about it. If you truly have a 6-weeks or even a 2-3 month PSADT, it won't be long before you are at that magic PSA # anyway. So better hit it while the load is small.
The best thing you can do is find a good top-notch medical oncologist. (PLEASE DO NOT INTERPRET THIS IS BLASTING YOUR CURRENT DOCTORS!). Whether it is a "name" guy like Myers or Scholz or someone else with good vita at a big-name institution, try and find someone. I think I posted elsewhere that I crafted my own criteria. Here is what I posted:
I am very worried due to my relatively poor pathology and my post-op fast PSA doubling time (two months). After a lot of consideration, I’ve decided to use my last curative bullet, SRT, without HT. Should SRT fail, my choices will be fewer and less certain. I will want a doctor who excels in the ART of treating PC. In short, I’m looking for a very knowledgeable doctor who thinks well INSIDE the box but could go OUTSIDE the box if truly warranted. I would want a doctor who is experienced with advanced PC, knowledgeable in all aspects of this disease (including the latest research regarding drugs, tests, genetics, diet, etc.), and compassionate. In short, someone who will listen to my concerns and answer my questions. My goal is to live many more years, productively, with a good QOL. I’m sure that’s probably the goal of almost every advanced PC patient! In my particular case, since I live in Michigan, I would hope we could do a few long distance consultations in addition to a few regular appointments and that we could arrange to do some tests, if necessary, in Michigan. "
I formulated this before my doctor search. I bet if you thought about exactly what you want in a doctor, some or all of the above would be uppermost in your mind too.
In terms of tx. and options and when to use them, it seems if you find the right doctor, then he/she will answer all of those questions. I know in that Scholz video (I posted that link in the other thread; let me know if you can't find it), he mentioned myriad tx. So, maybe some doctor can suggest another alternative to HT. But that begats another question. You don't want HT because of its known horrendous SE and your particular disposition to SE. You understand that chemo and many other drugs also have terrible SE. But, again, this is where the information gleaned from a SUPERB DOCTOR might come in handy.
David: are you willing/able to travel? Maybe if you find the right doctor, you can just have a consultation and then he could work with your local oncologist. That might help in terms of convenience and cost (traveling and maybe even insurance considerations). Another thought: Is Duke that far? Maybe they have some fine doctors. I am in a couple of groups. If you'd like, I can make a post seeking experts in SC or nearby. Maybe some of the participants can mention some names based on first hand experience.
Let us know your follow-up thoughts.
Remember, you, Sonny, and I are having very similar experience. You are 1/2 step behind Sonny and I am one tx. behind you! (Another thought: I think Sonny is seeing someone at MD Anderson. Why not call him and see what he thinks).