Newspaperlover, you are having, in my humble opinion, very favorable outcomes with you 4+4 case of PC. Allow me just recap why I'm saying that...
A 4+4 case is very clearly in the "high-risk of recurrence" category, so there was really very little surprise that you did, indeed, have a recurrence.
Roughly 3 years passed from SRT+ADT until recurrence. Those who recur within one year are many, many times more likely to develop distant mets, develop castrate resistant PC, or die from PC compared to those who recurred at greater than one year. Your recurrence was 3 years.
Your PSADT is excellent. I rechecked your 4 numbers (I agree with initiating PSADT measurements only with data above 0.2ng/mL) using the tool HERE
and found the result to also be just under 14 months. (I used the 15th day of each month.) This online tool applies least squares fit to untransformed data, and it also gives a nice chart output. Eyeballing chart, I'd say your calculated PSA won't cross 2.0ng/mL until summer of 2019.
Your PSADT is close to the point where some doctors might suggest "observation" rather than even starting SADT (Salvage ADT)...not that your PSA is even high enough to start it now, but I'm talking about
later. Check out THIS
paper where no patient in the cohort of PSADT>15 months even experienced PC-specific mortality within the follow-up period. The author's comment was that "...it may be reasonable to initially observe patients with very long PSADTs after biochemical failure post-SRT and reconsider starting SADT should these patients go on to develop shortened PSADTs during follow-up.
" You are not quite at 15 months, but close enough for it to be a strong factor when weighing all considerations.
Post Edited (JackH) : 5/30/2017 1:12:42 PM (GMT-6)