The hope of the treatment team was that salvage therapy, if deemed advisable, could be particularly focused on the site of my recurrent cancer.
That's where you went astray. It was not
the purpose of the PET scan to find where, in the local area, the cancer is. The purpose was to rule out that it has already metastasized to distant
locations. If it is known to be distant already, then local treatment would be futile.
You also misunderstand what a PET scan can and cannot detect. It can detect metastases that are about
4 mm in size, but if the mets are much smaller than that, it is unlikely that any PET scan can detect it. A clump of cancer cells is on the order of microns
in size (about
one-one thousandth the size that a PET scan can detect). These are called "micrometastases" and they can be anywhere - hopefully still confined to the local area.
Salvage radiation should never be used to treat a single locus of detectable cancer because we know there is likely to be more than that. You have to treat what you can't see as well as what you can see. Yes, it would be reassuring to have found a tumor in the local area. Then you would be more comfortable in attributing your rising PSA to local progression, rather than distant micrometastases.
The new genetic test that Genome Dx is giving along with Decipher is called PORTOS. They claim it measures the radioresistance of the cancer. Maybe. It may alternatively be measuring the genetic breakdown that occurs when cancer metastasizes - so it may
be a biochemical indicator of micrometastases. If the former, more extreme salvage measures may still work. If the latter, salvage curative treatment would be futile. You can read about
it here:PORTOS: a gene signature that predicts salvage radiation success
Be careful in interpreting what I wrote in that article about
SRT saving lives. Those researchers were only doing a retrospective analysis with median f/u of 6 years. We know that the median time to prostate cancer death was 15 years or more, and that modern medicine has extended that significantly. So that study did not have long enough f/u to discern the PSA that really makes a difference. The following article references a study with better data:Very early salvage radiation has up to 4-fold better outcomes and saves lives
I don't think there is any controversy that patients do better with treatment at the earliest possible time after recurrence is certain. You are right that tertiary 5 is a high risk characteristic. If you want more time for recovery, starting ADT now will halt cancer progression and give you more healing time. You typically use it for at least 2 months before the radiation anyway, so what are you waiting for?
BTW - I'm a big fan of Mindfulness too. It helped me get past my anxiety and into a more rational frame of mind. I still practice it, although it's almost second nature to me now.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.2,no lasting urinary, rectal or sexual SEsmy PC blog