Visit to my RO - slowly rising PSA after SRT

I had a number of questions this time for my rad onc, and they pretty much reinforced what updates I have learned on this forum.

After prostatectomy, recurrence, and SRT are several years behind me, my PSA has been slowly rising - it was up to 0.15 in Feb. Without supplementation, my T is in the 100-200 range. My current uro oncologist has been OK with supplementing to 500 until my PSA velocity increases (he hasn't really clarified what level will be the trigger). I have pretty much made up my mind that I want to supplement as long as I can until mets show up, and then with evidence, radiate them. I plan to eventually go on HT, but not before I have to.

I wanted to see whether my rad onc would be on board with the approach. He is a warehouse of knowledge and statistics - I have been very impressed by him in the past.

He told me that there are a number of his patients that have gone on HT and decided it wasn't for them. He concurs that, without evidence of mets, it is not necessary. His approach is to wait until PSA rises to the range of 4 to 6, and then scan. He prefers the new Sodium Fluoride PET scan, but that insurance is hit or miss at this point - but not to worry, by the time I need it, all of the insurance companies will cover it. On the topic of spot radiating discovered mets, he said that it is not a particularly high cost issue that the insurance would have a problem with (actually Lupron poses a greater cost to them). He said that there is also no prerequisite that HT be used first.

I started asking him about steps past this point, but he told me that I am being premature - there are so many new treatments coming online (particularly the one that routes radioactive isotopes to target micromets - it has been referenced several times on this forum). I agreed, and figured I have the next 5 years or so covered with this plan, I don't need to do too much in the way of excessive brooding on the steps beyond right now.

I'm not really asking for advice in this post, just sharing my point of view and experience at the doc, in case it is relevant to anyone else in a similar situation. I'll say my doc reinforced a lot of recent information that I have found useful from this forum, and I am grateful for this group of guys (and their supportive gals) that I have learned from.
Jeff

Thanks for posting this. I might be next in line and like you I'm hopeful for great new solutions in the coming years. I also believe that our primary and secondary treatments allow us to push the clock forward or buy time by stopping the progression for hopefully many years.


Best,

Luther

This disease is a lot easier and cheaper to treat if you can keep detectable mets, especially bone mets, from developing..Things get much more serious after that. Survival after bone mets have been detected is not very good... If your supplementation with testosterone speeds up the metastatic process, I would think twice about that....

Jeff,
I think that's a very sane and well thought out plan - maintaining QOL while minimizing risk, and taking full advantage of available data. You seem to have a great oncologist, and a great working relationship with him.

- Allen

I'm continuing this thread, with a new data point. My most recent PSA level is 0.27, almost a doubling in 4 months. Although I am amenable to continue T supplementation for now, my rad onc uro is not. He wants to wait 3 months and see how the PSA changes. He is concerned that a rapid rise indicates non-local growth.

If any of you have some recent articles that would argue the case for T supplementation in potentially metastatic men I would be interested. My uro is not sold on saturation theory, and with my natural T level these days somewhere between 100 and 200, I suppose it is possible that it might be low enough to be below the saturation level on its own anyway.

Still trying to sort this out... Bummed that my T levels are on the way down. Bummed that my PSA levels are on the way up.
Jeff

Allen, following your logic -
If the PSADT slows down when the TRT is removed, then TRT is doing me no favors - and therefore stop it.
If the PSADT does not slow down when the TRT is removed, I suspect it will be very difficult to convince the doc to start supplementing again - he will cite an abundance of caution.

So looks like the TRT is a thing of the past, unless we try the experiment over again.
Jeff

@Im_Patient, I'm sorry to hijack your thread but so far you are the only one I've found on HW that has done SRT and has UC. I need to ask you some questions. My email is in my profile. Would you mind emailing me so I can ask you some questions? ~Miki

Thank you Jeff. I sent you an email back and we got news today. I will update on the thread I have going but I will send you an email also.~Miki

Your posting name fits you well. whats your age?

No it was a question? A persons age is not irrevelent to advice. Your dislike of me is showing. what did I ever do to you, other than exist....Good Lord... I assumed you were older based on your wisdom...your response was a much better indicator of that age

All advice is appreciated - we must have mis-read one another.
I'm 56, and have been on this strange journey for 8 years.
Jeff

Jeff,
If your PSA drops when your T level drops, the TRT was exacerbating the cancer - why is your Uro then OK with giving you testopel?
- Allen

Jeff- that sounds like a prudent plan