Quality of life vs. Quantity

Not sure what I'd do at age 76, Progressing. I tend to lean towards the philosophy that life is precious, protect and preserve it at (almost) all cost. Also, it seems to me if you are really otherwise healthy, it's worth fighting to extend life.

But at the end of the day, there's only one person that can know the right answer for you. And I 'm sure you know who that is.

You are mistaken in your belief that living with advanced disease has no impact on quality of life. In fact, those who begin HT earlier rate their QOL no differently than those who start it later when metastases are apparent. So if QOL is a wash, it comes down to quantity. Also, men living with advanced disease are more prone to die from a host of other illnesses. Living with significant amounts of cancer in one's body is debilitating - it will "slow you down" more than ADT.

Why do you think you necessarily have to have ADT with SRT? That is not written in stone anywhere. But if you decide for adjuvant ADT, it is for a very limited duration. SRT carries risks of urinary problems, but they are in the main transient and treatable. This option disappears the longer one waits.

There are many more possibilities than the ones you enumerate. You can also decide against SRT but for hormone therapy. Hormone therapies can be done in many different ways. For example, one can start with an aggressive hormonal approach in the hope of an extended vacation after a significant dent is made in the metastatic load. Or you can take a "lite" approach exemplified by Traveler29 who only takes two 50 mg Casodex +raloxifene a week. Or you can take a middle path with intermittent lupron with vacations.

Lots to consider and weigh Progressing. The entire QoL trade-off is very personal, and most docs undervalue it, IMHO.

I can totally empathize with your dilemma, since I'm in a similar persistent PSA situation. A lot of persistent PSA going around. May have something to do with the limits of robotic surgery, but who knows.

I'm a 'young' and vibrant 72; never a PSA over 3.5; surgery 7 months ago; good pathology G 3+4 & one small positive margin; PSA from .32 to .54 over the next 4 months, one inch tumor discovered upon DCFPyL PET scan at the NCI....and then - what to do?

For me it's SRT, even with my dormant ulcerative colitis, and after many world class RO's and GI's cautioned me about probable heightened toxicities.

I was, an am, doubtful about the real benefits of ADT given my history and pathology, but due to almost universal advise to do it (thanks, TA), here I am on two months of Casodex and 5 weeks of Eligard (Lupron). RO's advise it for the same reason Barry Bonds took PED's, except that the RO's don't suffer any ill effects. Mild SE's for me so far and life is still good, except I finally know what ED and loss of mojo is all about. Plus I am becoming a bit more cynical...if that's possible. The small man-boobs are cute.

Simulation last week, and radiation starts in two weeks. My apprehension is about long term radiation effects and toxicities, much more than relatively short term ADT annoyances. But this is my one shot at slaying the beast, so I am reluctantly committed, and all in. Note there is no way I going beyond six months with my 2ADT.

Of course the fact that I'm scheduled for radiation at a Taj Mahal like, new VA hospital, with all the latest equipment, in Lake Nona FL, and I'll be overseen by a brilliant RO researcher (not clinician) recently with the NCI is surprising for me. If you told me three months ago that I'd be going to the VA for treatment, I'd have laughed in your face. The physicians at the VA, however, have been first rate, with the bureaucratic, employment-for-life, clerks irritating nuances at times.

Who knows about the actual techs handling the radiation...how easily can they screw it up, I have NO idea. I will have a immobilizing cast and a rectal balloon. 39 fractions, 70.2 Gy, of which 3.6 will be aimed at my one inch tumor. I trust they aim well.

There are several RO's who have suggested, off the reservation, 25 fractions for about 50 Gy, with a short course of ~21Gy or so of Brachy directly into my tumor. Does this make ANY sense, TA???

So that's my story, and my doubts.

Two items for you to consider and research, are that I believe doubling time at so low a PSA tells you very little, and the artificial 0.2 PSA line, given your pathology and being post RP, rather than post primary RT, means less and it probably way too low. This is from world class RO's. I know, clear as mud.

Of course they, like us, have much less certainty than any of us like on our journeys. Best of luck with your choice!

Post Edited (garyi) : 2/18/2018 5:57:45 PM (GMT-7)

More thanks. Yes, garyi, the RO (or surgeon or I suppose any doc) opines without any effect on him or her.
Used to visit Lake Nona in another life and glad the VA is doing well for you. My closest VA is an hour, so think I’ll stay with MSKCC.

Been following both you and Saipan as you’ve travelled the road I’m facing. SP, good on your dad. For me a cure, or even delayng BCR for several years, would be great. Way back in my journey, when a radiologist thought he saw a met, Tall Allen hoped if it wasn’t (and the MSKCC re-evaluation and their MRI said it wasn’t) and that a cure was still possible. Seems a lifetime ago (six months).

Maybe this is just a thought exercise, but of course that’s how Einstein found his way to the theories of relativity.

Progressing
Since you’re sort of “on the bubble” with intermediate risk PCa you ironically have more choices and you’re fortunate that you do. But having more choices can cause as much anxiety as having few or none. TA makes a great point when he asks why you would choose to live with cancer in your body if you could eliminate it or substantially slow down progression with no lasting side effects.
My biggest fear is dying a painful death with bone mets. My second biggest fear is undergoing debilitating chemo or other treatments which I face. At one time I feared RP, RT and ADT . I fear none of them after undergoing them. As usual fear is the biggest enemy and reality for me has always been less fearsome than I expected. If that makes sense?!😬
Bob

My thots on this guys is it seems like every month or so we hear about a new trial or treatment so who knows a cure might be just around the corner in my opinion that is 1 good reason to try to fight this darn disease and keep it in check. After spending 7 weeks at the hope lodge and seeing people in the very late stages of cancer I'm with TA in that believing putting up with some SE's is pretty mild compared to the ravages of late stage cancer. Each person of course has to decide for themselves.

Larry

Hi "Progressing"

Been down the road that faces you with Option 1, albeit a bit younger (50 at DX, 51 with ADT and SRT). ADT was a pain whilst it went on (did 22 months) but most side effects dropped off (apart from ED, but that may be due to the SRT). On the ADT front from my perspective, I wish I had kept myself a LOT fitter and been more careful with my diet, as I am now overweight and have type 2 diabetes.

SRT left me with urinary strictures, the repair of which has left me incontinent. This has affected QoL a lot - again could possibly have been better had I looked after myself better.

On the plus side, I am still here for my wife, children and growing number of grandchildren, still employed and paying the mortgage.

Tough dilemma, and I feel for you.

If you would like a woman's point of view, I say live life to it's fullest.

If my husband had been diagnosed at your age (and I wish a thousand times a thousand that he had) I would have encouraged my husband to not go through surgery and to enjoy every minute of every day.

You've gone through enough. Live and enjoy.

More thanks for your counsel, which I’ll take on board, including the vote for living it out. If I’m still playing golf at 87 like IT’s dad I might even shoot my age.
With the responses here and the current threads on ADT/SRT, knowledge/self advocacy, and others where I see many of you initating and posting, I’ve learned a lot. Don’t know what the RO will say in two weeks, but the MO did get me thinking about benefits and costs, and each of you has stimulated more thinking.
And do know that I am grateful for the support from members of this forum.
Fear indeed is the #2 enemy behind the PC itself, but as TA reminds us mindfulness can help us deal with it.