next psa test in 8 months ?

4 months after STR finished DH has a psa of .16. We're very happy about that! The radiologist says next psa test in 8 months and then yearly after that. With DH's extensive G9 disease I'm a little surprised he isn't checking it sooner. I also expected a testosterone test which wasn't done or even mentioned. The radiologist also says no need to see an MO, or have any other bloodwork done, just come back in 8 months after next psa.

DH hasn't had any ADT with his surgery or radiation.

DH is very happy to just be done with cancer and not think about it until next 8 months appointment. I'd like to feel that way too, after a year of anxiety and sleepless nights. It seems too good to be true that he's good to go for now.

My first inclination is that I would want more PSA test frequency at least in the first 18 months. I have been on quarterly draws and my uro wants to stay on that schedule. I personally am not ready to go much longer, let alone 8 months. On this I would appreciate the doctor's input, but I would follow my gut.

A mid-point is to have your PCP or on-demand-lab pull blood in three months and if the PSA hasn't moved up then go with the rad-onc at 8 months. If it has moved up, then good that you would know and can get back in to the docs to determine whether it is time for additional treatment.

As to the med onc, with the risk profile you present, I would have one at least in the background. Now could be a great time to go shopping for a med-onc. I wouldn't want to be starting that process if the PSA was moving up. We generally say that if the surgery fails, then the uro is no longer directing the traffic. Same could be said if the SRT fails regarding the rad-onc. Prudence tells me that a good relationship with a strong med-onc could be very beneficial. As my mother often said tis better to have and not need than to need and not have.

Upon re-reading the signature, I am wondering why you wouldn't already have a good med-onc and why there hasn't been ADT in the plan. I am not criticizing, just wondering. At dx I presented a lower risk situation and everyone I interviewed said they would include ADT, they just didn't all agree with the initial duration. My gut says to get a med-onc that is very experienced and successful treating men with his risk profile.

Thanks Sophie, I went back and looked at some of your earlier posts and now better understand the situation. I certainly understand your frustration.

Their approach appears to be significantly less aggressive treatment than many other G9 men on the board, in fact less aggressive than many G 7 and 8 men as well. JohnT has often said the problem is that low risk is over treated and high risk is undertreated. And there are two schools of thought, one uses sequential treatments in response to rising PSA and the other says to hit it hard when PSA is low in an attempt to be curative. This approach is what Kwon at Mayo practices and what my doctors did.

I will stand by my original suggestion and get PSA each three months and monitor this closely. I would have thought a trial would require close monitoring.

Sophie,
Gary is the same. Never second guess or question his medonc. What I told him is that his doc is his advocate, and a whole lot of other peeps advocate too. I am his advocate and no one else's. Do what the guys said, celebrate like crazy that you beat the G9 beast! At least for now and hopefully forever, but 3 mos from now, I'd be getting a PSA done (because why not?).
Beth

As a G9, he will always being in a higher risk category for recurrence. He will need to have his PSA watched pretty closely, with regular testing.

It's scary, but things seem to be heading in the right direction. Personally, not being on ADT, even for a short 6 month time is a bit confusing, as there have been benefits seen of being on that before other treatments. But, as I said, numbers are trending in right direction now, so just celebrate that, don't look back, and just stay on top of it!!!

Sophie, there are terms that can be confusing. High risk includes people with G9 grade, so he definitely is high risk. Advanced refers to where the cancer has spread. It can be locally advanced or distant. Locally advanced would refer to cancer that has escaped the prostate capsule but is still in the vicinity, like in the bladder neck or seminal vesicles. Advanced on a distant basis would mean it is in the bones, lymphatic system, or other organs that are not adjacent to the prostate. Each level will determine the type of treatment and whether it is intended to be curative or palliative.

You need to ask this of the lead doctor. It is clear he is high risk as that is a very easy definition and not up to interpretation. That it appears he had bladder neck involvement (if I am reading the signature correctly) could mean the cancer is also locally advanced.