Doubling time based on these low PSA numbers may not be accurate, but from eyeballing your signature it looks to me that your DT is probably somewhere over 6 months. If that holds you could still be a couple of years or more from a PSA in the range your URO recommends for starting ADT. I'm a bit surprised at your MO wanting to dump the decision on you without giving some guidelines based on his/her experience.
Here's my situation and my decisions so far with a lot of consultation and guidance from my MO. My PSA became detectable again about
4 years after SRT and a year or so later when it rose to 0.2 I moved my care from my RO t UMass Medical Center to a MO at Dana Farber. My MO said that based on my long intervals of low to undetectable PSA after ORP and after SRT he was inclined to let PSA rise to at least somewhere between 5 and 10. In 2017 my doubling time started to shorten at an increasing rate - from 9 months or so down to not much more than 2 months by last May.
I enrolled in a clinical trial and started ADT last May. I was randomized into the trial's Degarelix-only arm - the same treatment I'd have gotten without the trial other than extra blood work and long-term follow-up. The trial's other two arms were Degarelix plus Apalutamide, and Degarelix plus Apalutamide, plus Zytiga. My response to Degarelix (Firmagon) was a PSA drop to from 6.6 to 0.45 in one month and then to undetectable (0.02 - the tests lower limit). When I met with my MO a couple of weeks ago he said I probably lucked out by getting just the Degarelix because either of the other arms would have probably been over-kill with added SE's. He said he doesn't always see such a fast and persistent drop to undetectable and based on that he's inclined to let let my PSA rise further after it returns than he might otherwise before starting the next round of ADT.
Of course, unanswered and unknown, is will I have a similar, better, or worse, outcome over my remaining lifetime compared to the guys in the other two trial arms. But based on what we know so far I avoided some near-term side effects that may or may not have improved long-term outcome.
The problem with PCa when it reaches this stage is what to do, when to do it, what combinations of treatment to use is as much art as science. What a doctor might suggest for one patient may not be what the same doctor might suggest for another patient with a different history. We as patients have to find doctors we trust to share their experience, their best guesses, etc., and then we do pretty much have to make decisions for ourselves. Again I wonder why you MO isn't at lest sharing educated guesses and outlining options.
-2002-PSA 9.4, 5 of 10 cores 30-50%
-RP 2002 PT3B N0 MX Gleason 3+4 75% left lobe small focus rt lobe
-PSA low 0.01 slow rise to 0.4
-SRT 2010 1 lymph node targeted. Casodex during SRT
-PSA 0.00 thu 2014
-0.02 Oct 14; 0.04 Apr 16; 0.2 Oct 16; 0.51 Jan 17; 2.46 Jan 18, 4.19 Apr 18;
-6.62 May 18 enlarged lymph node start Firmagon; PSA 0.45 Jun; 0.08 Jul '18; 0.02 Mar '19
Post Edited (Bohemond) : 4/20/2019 11:12:40 AM (GMT-6)