hormone treatment

I believe your question relates to at what point in PSA rise will doctors recommend hormone therapy after SALVAGE treatment "fails".  At that point, the recurrence is no longer considered localized, and is systemic disease --- problem is, you don't know where the cancer cells are that are generating the PSA.  The next step in the normal course of action is hormone therapy.

I discussed this with my doctor, and he said he'll let the psa "run up" some before initiating ht at this point (he never gave me a definite number) for a few different reasons.  One, he's seen instances where the PSA might run up a little, but then stabilize.  Two, at this point you really need to get an accurate reading on PSA velocity to gage how aggressive the recurrence might be.  And finally, you have time.  "PSA only" recurrence will often preceed actual clinical evidence of advanced PCa by YEARS in many cases.   PSA doubling time will give your team some ideas in treatment options.

My doc also said not to panic at that point --- he's put patients on intermittent HT, and has seen cases of durable response to ht --- suggesting a curative result from a treatment not considered curative.

This is merely my understanding of the situation --- other members might have a better handle on this.  I'd also recommend posting your question on the American Cancer Society Prostate Cancer bulletin board ---- all questions there are answered by experts and staff members.   You can also call their 24 hour hotline and ask -- 1·800·ACS·2345.

Hope this helps -- good luck!

RB and friends..

   I guess I withdrew into a shell for a few weeks but here is an update, all your thoughts are sincerely welcome.

No prospect of DaVinci or anything else until I lose weight. Petitioning insurance company for Lap Band surgery and there is not a single bariatric surgeon in my state of NM. Primary Care physician gave me a referral to Colorado and another to Arizona, both rejected. Dr Fagin--who I have never met but who is a saint in my book--referred me to the two top bariatric guys he knows in Austin. Their offce was responsive but unless I want to pay cash upfront it is unlikely they will get added to my in- network plan....so I am in the final stages of weight loss surgery  at the ONLY approved insurance center, one in El Paso with two guys who are young, fairly well experienced, definitely not part of anyone's A-list but they did train in Galveston, the same place as Dr Fagin's guys.

No PSA's taken since my DX in July or my visit to Dr Guillonneau at Sloan Kettering.

about three weeks ago my local urologist who I like and trust, said neither he nor I like "watchful waiting" and he stuck a hormone needle into my stomach that left a bruise for a week but didn't hurt much. I don't know what the drug was, and I didn't care. he said I need a shot every three months until  my prostate is removed.  He gave me a Rx for

50mg of Casodex once a day. First Wal-Mart said the 90-day supply would be $545, then they said my insurance indeed had it on a copay list so the cost dropped to $105.

Two days ago I got the Insurance companies notice that the in-office hormone shot--are you sitting down?   $1,800 of which they "allow" $1,200. I won't even talk about the "great" policy I have that includes an annual deductible of 3k or 5k or whatever...

As with some of you, the combination of three blood pressure pills had killed my libido more than 5 years ago, but occasionally the little guy stirred down there in the middle of the night---3-4 hours after one pill and 3-4 hours before the next one...yes, I tried the blue pill and it didn;t work...but at least once or twice a month my wife knew I was alive...the hormone pills and shot killed that off...at a meeting yesterday conducted by a charming, intelligent, vibrant 20-something Ph.d, blonde 5-foot-11, movie star smile, etc. for a fleeting moment I wished I had just been born a ***, period.

Okay...I'm hauling slash, riding my ATV, getting ready for winter, going to work, emailing my son in Iraq, and basically only discussing this with you guys and gals..

mbshine