You're quite right that PSA of .2 is standard definition for biochemical recurrence after prostatectomy. That is based on the fact that for a long time, .2 was the lowest PSA that could be reliably measured; and most of the randomized clinical trials that demonstrated an advantage to earlier treatment began before accurate lower measurements were possible or routine. In an interesting analysis, my RO found that, among high risk men, any PSA value ≥.03 reliably predicted that the PSA would rise to ≥.2.Ultra-sensitive PSA Following Prostatectomy Reliably Identifies Patients Requiring Post-Op Radiotherapy
But to address your concern, you said, "I see that there is some small risk of cardiovascular and diabetic problems with the hormone treatments. I am borderline for both and am wondering if I should forgo the HT until it becomes a necessity."
The clinical trial you describe (is this RTOG 0924?) mentions only 2 months of HT pre-treatment before radiation. Usually, there is concurrent treatment as well, which would bring the total to 4 months, or often, they do 2 months after, which would bring the total to 6 months. If it's RTOG 0924, the doctor may give the patient up to 32 months of ADT at his discretion (not randomized). I've never seen anything that showed that 4-6 months of ADT was associated with cardiovascular or diabetic problems. Even with 1.5-3 yrs, I don't think it's a big concern, although close monitoring is important. It is only with much longer term HT that those become a concern.
However, even if there's little reason to be concerned about
those side effects, there are a couple of other considerations that only you can answer:
(1) Are you indifferent to whether you are assigned to the 3 alternatives? ADT has proven to be beneficial for high risk PC in a recent clinical trial (DART 01/05). GS8 also carries greater risk of lymph node involvement, although it is not at all clear which protocol is optimal.
(2) Should you be opting for longer term HT? High risk cancers, and your GS 8 puts you in that category, generally respond to HT for at least 18 months. Your lack of positive margins increases the likelihood that such long-term clean-up may be required. If this is RTOG 0924, your doctor may be able to prescribe longer term ADT at his discretion.
If this is RTOG 0924, it is a very important study that may lead to great improvements in the way men with recurrences will be treated in the future. You will be closely monitored, and all radiological design is very precisely controlled as well. Your participation would make a valuable contribution to the rest of us.