Well, we met with Dr. Scholz today. He has a very nice office (surprisingly it was not huge) and excellent staff. Our appointment was at 4:00 PM. We arrived 15 minutes early and filled out a bit more paperwork (not much). By 4:10 the nurse/office assistent (not exactly sure of her title) chatted with us, took my vitals, then took blood for a bunch of tests (including the one we all know and love: the PSA).
After a brief pause, Dr. Scholz came in and we chatted for the next 60-70 minutes. I really liked him. He seems like a nice guy, extremely knowledgeable, friendly, and not at all arrogant. There is a quiet confidence about him. We did make some small talk, but 95% pertained to PC and my situation. I was also very impressed that we didn’t have to wait long despite being the last appointment of the day. That’s IMPRESSIVE.
The bottom line as to where we go from here is PSA-dependent and I will not have that information until tomorrow. He will call me himself tomorrow morning. But we did discuss various what ifs.
If my PSA behaves, then we do nothing. So my guess that he would suggest HT regardless was wrong.
Now, here’s a big surprise: IF my PSA does not behave, I do have one more shot at a cure. He says they can do radiation again to the pelvic lymph nodes. This might entail another 38 sessions. This would be coupled with HT. He says they have had good results doing this. He also said my course of tx. so far has been entirely appropriate (ie: radiating just the prostate bed without HT). However, that might have been a political statement aiming not to criticize the tx. of other medicos. But he made it clear my tx. was definitely an appropriate, standard tx (note: I just listened; I never questioned the tx. I had). Anyway, if my PSA rises I will have to think about going for the cure once again. I’m thinking no radiation.
Another very surprising thing he said: HT could buy me 11 years. Actually, that’s the median he mentioned. I questioned him on that because I’ve heard 2 years give or take a bit. He said that is for folks whose PC has metasticized to the bone. In my situation at this point it is extremely unlikely that’s the case. With my low PSA, there is no point in doing scans as nothing will show up (this is what I’ve been told by everyone). Unfortunately, there is also as yet no good way to scan and see where the PC is regarding the pelvic lymph nodes. They are getting better, but there is nothing yet.
I also asked him about my 2-month PSADT and if that means a negative prognosis for the length of time HT would be successful. He didn’t know. There are no studies showing this one way or the other. Also, as the PSA numbers increase, my doubling time might decrease, since my PSA numbers are quite low.
I also asked him the sooner rather than later question regarding the HT tx. He is clearly in the sooner camp, but also not too soon. Today’s PSA test is 60 days after SRT. He said it could actually be higher. Regardless, he would want to see a trend of PSA scores to indicate that SRT clearely failed. However, once that trend is established, he said that we should start HT. We discussed a few of the SE, but didn’t dwell on it. The 3 he mentioned that seemed to be the big ones were: loss of sexual interest/ability (just not a big concern for us), weight gain (significant/abdominal), and general weakness. Exercise would be a must.
I am currently dealing with some other issues and he did recommend I follow up with a pulmonary expert and a cardiology workup. It is possible that the SRT has caused these problems, but unlikely.
So, it is now waiting time. I’ll know my new PSA tomorrow. Regardless, there will be plenty of follow-up PSA tests, possibly monthly for now.
In summation, the cost was $600 for the consultation. I suspect the bloodwork will be billed separately and I suspect my insurance will cover most of the expense. It was well worth it. I was unaware that I could still shoot at a cure by radiating the pelvic lymph nodes. Again, this is one of the advantages of going to an expert! I don’t want to go through more radiation. Also, if HT could give me 11 years, by then there might be a lot more out there (he mentioned some things in the pipeline). He acknowledged that viewpoint also. Additionally, it sounds like I could do HT for a few years and then still do the radiation and try for a cure. It might be by that time that imaging techniques are improved. That would be great because then we can see where the buggers are and kill them.
Also, he is willing to work with my local doctors as needed and he does do telephone consultations. I am glad I went.
That's my report and I would welcome comments/questions from this group
Mel