Good point, I should have said "many" not "most". As you state the thresholds for recurrence from both AUA and ASCO (the oncology society) indicate that Shutterbug has experienced a recurrence. He is over PSA .2 and has had at least two increases separated by more than two weeks. He also appears to exhibit a PSADT of six or fewer months. That he has G8-10, which typically indicates more cancer volume at a given level of PSA, I personally would not be casual in my approach. Based on reading from oncologists like Myers and discussions with my own doctors, I believe that there are many doctors that would be currently formulating treatment strategies which would include ADT. Of course doctors will approach the same facts with differing treatments, but there has been much written by doctors and quoted on this forum about the early application of ADT in high risk recurrence/progression situations.
Often many learned members on the forum express that generally low risk is over-treated and high risk is under-treated. My doctors adhere to that and has influenced my treatment approach and my advice to others. Based on the facts Shutterbug is very clearly high risk. My concern for him would be that delays in accepted treatment protocols may be less effective at cancer control that could have very negative impacts. In other words, to me he risks being undertreated given his risk level. Yes, there are studies that have shown that early ADT doesn't necessarily equate with longer survival time, but Catalona also points out that studies also show that it does equate to longer survival when there is lymph involvement. Further, often a study is not specific to our own situation. I have often observed that higher risk situations are generally less represented, and brings questions about how clearly a given study applies. I certainly would want to find out, in the studies that Allen refers, how specific and valid they are to the higher risk G10 cohorts before being guided by the general conclusions.
Clearly all treatments have side effects and one must measure the expected effects of both treatment and non-treatment.
My post had two basic points to his request for our advice.. First, my advice: that if it were me, I would be seeking an experienced medical oncologist that has demonstrated success treating high risk G10 men.
Second, given that Shutterbug expressed an absolute bias against HT, my observation; that if in fact he won't ever do HT, then why concern oneself about testing? To Allen's point, I don't view that as a vacation from the situation, rather it appears as a retirement from the situation.
I encourage Shutterbug to share his bias against HT and whether it is just temporary or permanent. Perhaps those who have been through it can be of assistance with information that can either better confirm his current position or potentially provide clarification that enables him to reconsider using ADT. At the end of the day each of us own our decisions and accept the consequences, both positive and negative. I think one of the advantages of this forum is that members can get far more experiential information than from nearly any other source.
Shutterbug, I extend my best regards and wishes for you and your wife to have a wonderful winter in the sunny south.