I'm in a similar situation. After failed RP and RT my PSA is currently 1.2. My first MO's suggestion was letting my PSA go to 20 (twenty), find the bone mets with a scan and irradiate them. He would also start me on HT at this same PSA of 20. I thought his philosophy was shocking and counter intuitive but he said there is no evidence that starting HT early has any benefit. Starting HT at PSA 20 would give me more quality time before having to start HT. I did not care for this MO's bedside manner. When I started asking him questions he rebuffed me and told me to let him do the worrying. He has since moved his practice to a cancer center in a different city. I have met my new MO one time but I love his demeanor. He has not given me a definitive treatment strategy but I believe he will recommend HT when I reach a PSA of 2.0.
When to start HT for people after failed primary treatments is controversial. It is interesting that both of these Oncologists were at the same university cancer centers and both run drug trials, yet they have very different treatment philosophies. I will discuss early/late use of HT with my current MO and then decide. It's a tough decision. I want to start HT as late as possible but my intuition and emotions tell me it's not a good idea to just the cancer grow to a PSA of 20 before doing something. We always want to do something NOW, when sometimes it may be better to wait? Human nature, I guess.
DX: pT3bN0, April 2015, Age 54
Initial PSA: 20.8, DRE: nodules both sides
Biopsy: 12 of 12 +; 11 of 12 cores 80%-100%; Gleason 7 (4+3)
Bone scan: clear; MRI: Nodes -; SVs +
RALP June 2015
Post RALP pathology: Gleason 8 (4+4), focal areas of 5; 3 Nodes -, Margins, SVs & Bladder neck +, 51 grams
Adj. IMRT: Aug 2015
PSA post RALP: 0.2
PSA post IMRT: 0.1
PSA: March '16: 0.3 Major bummer!
Post Edited (mattamx) : 11/25/2016 4:31:23 PM (GMT-7)