Still curative or only palliative now?

Surgery in 2011, SRT in 2015, PSA up to 1.4 but stable for the last 9 months. My oncologist says I'm no longer curable and might as well wait until PSA gets to 10 or 20 to start HT. Last week he told me the cancer was most likely still local to the prostate area but that more radiation to kill it was out of the question. Is this the Dr. Kwon controversy going on now in the field, whether situations like mine are still possibilities for a cure--or not? Should I be more aggressive, like insisting on a scan and, if indeed the cancer is still local, looking into trying to eradicate it? Thanks in advance for your help and advice.

Thanks, TA, that's what I figured from recent postings on HW. I'm inclined to put off HT until absolutely necessary, but will be taking the TOAD study into account in making my decisions. The oncologist believes that with my profile I probably have a while yet, so right now QOL seems more important than several years tacked on to the end. I'm sure that attitude will change when I get there!

Negative margins mean that it is less likely to be local.

It reads "-margins" (negative margins) - not ambiguous.

Chask said...
Phenom, I am in a similar position. Had a PSMA scan in Jan which showed no visible mets (yet) but takeup in the prostate bed.

My PSA In Jan was .7 but doubling fast. I expected to go back on ADT then, but allowed myself to be talked into waiting another 3 months - purely for QOL.

PSA last week was 2.6, which gives very short doubling time. Maybe should have started ADT back in Jan, but too late to worry about that now. Seeing RO next week and will certainly insist on ADT now.

Chas

Hey Chas - do you mind an unsolicited comment or two?

Out of curiosity from my recent math explorations, I ran your signatures PSAs on a log slope. Based on everything before March, the predicted value for your March PSA would be.... wait for it.... 2.7. Reality? 2.6 (+/-0.1 probably as std PSA tests go). That's pretty close!

The PSA doubling time (excluding last September's above-trend reading, which should have been 0.25 or so based on the log slope), averages less than 2 months which is pretty short. Less than 3 months is a significant concern level from many studies.

Interesting (to me anyway), if you'd have made this analysis at your last PSA check, even though it was still less than 1, you and your onco could well have predicted this number, and maybe did. So, what criteria should we patients be using along with the doctors to help guide treatment plans like this? I do understand the QOL issues, having been on ADT for 3 years! Timing to restart ADT is sure a gray area.

The so-called Phoenix criterion of "Recurrence iff PSA>2.0" (with logic's "iff" meaning "if and only if") is only a standard to allow various studies to be compared. I don't think it was ever meant to be, nor should it be, used to guide clinical practice.

Your RO appointment should be interesting.