Posted 3/15/2017 11:19 AM (GMT -6)
"Hitting it with everything" is very incorrect if it is being stated literally. Using the aggressive method of the appropriate treatments is an appropriate course with "high risk" PCa as you have been diagnosed. You are not "advanced" according to your signature. You may be "locally advanced" but really can't tell.
This was me, "high risk" and at great probably of being "locally advanced" but no clear indication of it being "advanced". I used HDRBT, IMRT (including the pelvic lymph nodes) and 36 months of ADT3. The ADT3 was the standard based on the BOLLA study for "high risk" dx. I was never recommended to add chemo as there was no medical evidence that it would improve the cancer treatment, but it would introduce more toxicity and side effects.
More recent studies have moderated the length of ADT more in the 9-24 month range, but in "very high risk" situations 24-36 months is used. As I recollect, early chemo therapy can help when mets are present at diagnosis, but not otherwise.
To TA and RW points, I agree that it is easy to get too many doctors in the mix and then their often misinformation about treatments out of their expertise will lead to confusion by the patient in making decisions. Right now I would go with the RO as you have chosen that method for your initial treatment with hopefully with curative intent.
So, how long for ADT? You don't have to make that decision today, but most everyone will say at least nine months. Should you go 12, or 18, or 24 or 36? I don't know and neither do the doctors with 100% certainty. In your case I would expect 18 months at least. And due to the G9 maybe a bit more. If at that time there are no signs of problems you could take a vacation and see what your PSA does. If it stays down it might indicate you will not need further ADT. But that isn't certain. If the PSA starts up, it would indicate that you will need ADT for a longer time.
But why worry about that now? You know you will have some period on ADT and whether it ends up to be 18 months or 28 months should in no way be a consideration today. Now is the time to go all in physically and mentally with the initial radiation treatment and primary doctor leading the team. The rest will play out in due course. Will you need a medical oncologist? IDK. If the initial primary treatment doesn't work, then yes you would go to the mo for longer term maintenance therapy that is primarily drug oriented. But you will cross that bridge if and when needed.
In my own situation, I appreciated that my doctors were of the opinion to be more aggressive and so we went with ADT3 for 36 months based on BOLLA. So far I have been PSA undetectable for more than 6 years, so I continue to be supportive of the approach. What no one knows is whether 18 months would have been as good. But that is water under the bridge and doesn't warrant consideration. Done is done.
As to who monitors after the initial radiation treatment? My urologist has seen me every three months and I get PSA and T measurements. He also administered the ADT3. Due to the "high risk" dx and the probability of recurrence in my present time frame he chooses to monitor each three months and I appreciate that. For the first year I saw the ro every three months, then went to six months and now yearly. He mainly monitors me for radiation side effects and keeps my progress in the database for their long term treatment studies. It is now optional on my part if I want to continue to see him. For you, I suggest the doctor you trust and have a good relationship with. It will encourage great discussions about not only the PCa but other aspects of your life that it affects as well as keeping up with the discussion of new breakthroughs and the aspects of what if the cancer returns. What will be the strategy? I was fine with both my ro and urologist playing that role, but in their team approach the uro does the long term monitoring. They also find that the normal male side effects encountered with the urinary and sexual functions are for the urologist anyway.