I had my routine follow-up with both the uro and rad-onc. PSA remains undectectable. No lingering radiation SEs. However, I continue to argue with myself (quite the trick
) over the length of time to remain on Lupron. I am at 14 months as of Jan 1.
Uro pushes that 2 years is enough. Rad onc is pushing 3 years total. The rad onc references the various studies (Bolla, etc.) showing 2-3 years of HT combined with radiation makes a big difference. Since I am very high risk (PSA in 50s, bi-lateral SVI, G9) he wants the full 3 years. I push back on the studies and say those were with men that had not undergone a prostatectomy. Rad onc's view: true, but we extrapolate the results and medicine is also partly art -- they want 3 years. And, rad onc is convinced that some degree of systemic spread for me is a certainty, even if it is a few rogue cells. They will accept 2 years if that is what I am willing to do. I would love to be done with it at 2 years, but, of course, if I thought one more year would make a real difference I would stay on another year without hesitation.
The vibe from the rad onc's office is essentially this: I am probably still in trouble and need to be aggressive.
I am just thinking out loud here. It is a mind game for me. I have plenty of time to decide. But, if it is 2 years on HT, then I can soon start the 2012 mind-game count down .. looking forward to beginning the T recovery in 10 months. If it is 3 years, I just need to put the whole issue on the shelf and forget about it for now -- too far in the future to think about much.
Having said all this, I am feeling very good despite the HT. I work out and am in good physical condition. I do get the hot flashes and have total ED but otherwise I feel strong and seem to be doing well in all other respects. So, staying on HT is not a huge downer by any means.