Opinions on urologist visit?

Guys

I saw my urologist this morning, and would like opinions on whether his advice/recommendations appear in line with what others have heard -- realizing, of course, that our cases are all different.
To summarize my situation, I had RP in 2009 (G4/3), had 0s for the first year, .05's second year, and now a jump from .05 to 0.13 within the last 3 months, 2 1/2 years from my surgery.

My urologist, whom I respect, says he does not recommend SRT at this time. He's concerned with the big jump, which may indicate recurrence, but still thinks it may still be benign tissue left behind. He doesn't want to overtreat at this time with radiation, but prefers to keep getting PSAs at 3 month intervals to see what it does. If it gets over 0.5 he would recommend SRT and, with my Gleason 4+3. HT along with the radiation.

I asked him what type of HT he recommends in those cases and he said he prescribed one that brought the T down fast, followed by 6 months of Lupron. Afraid I can't remember the name of the first one but I think it started with a D.

When I expressed concern that waiting may allow the cancer, if present, to spread, he said if I wanted he would refer me to radiation now. I told him I didn't feel ready for that step yet but would like to take action at some point before 0.5, maybe around 0.3 or 0.4.

So, not sure what to think at this point. Anyone care to comment? I'd appreciate it.

A lttle early for SRT. Typically the protocal is 3 consecutive rises and a PSA over .2. I assume you have negative margins and negative seminal vesical.

In my humble view, I think its way too early for you to think about HT. You would go there only if SRT failed, which you won't know until after you are complete.

There are protocals that combine SRT and HT, but usually in situations that are much more serious than yours. G7, with clean margins and no reason to suspect spread beyond the pelvis seems, to me at least, not to indicate HT. Perhaps its time for you to discuss your case with an oncologist, not a urologist.

just my own view.

I do not believe that it is a beniegn tissue issue, not this far out, and not after pulling zeros for so long. However, I wouldn't jump into SRT based on the one reading of .13. My local doctors considered recurrance at 3 increasing readings over .10, right now, you just have the one reading. If he does have recurrance, then I wouldn't want to wait till the PSA hit .50, doctor's vary on this line in the sand. I would say, if there are 2 more increases over .10, then I would make plans to hit it before the PSA hit .20. The earlier you hit it, assuming any remaining cancer is in the prostate bed, the more effective SRT can be. The trigger may need to be pulled, but definitely not based on this one reading.

david in sc

HD,

Your fears are well founded in my opinion and experience. At best, its an educated (?) gamble. The hopes is that the remaining cancer is in the prostate bed. SRT failure rates can be surprisingly high, in my case, I was only giving a 20% chance at best that it would work. Considering what happened to me with SRT, in hindsight, I should have avoided it at all cost. For me, it ended my working days, left me with chronic pain and chronic fatigue, and due to the faulty administration of it, left me with a destroyed bladder and bladder neck, needing a urostomy for life. Was it worth the 20%, for me? Absolutley not, wish I had a re-do button. And the worse part, is that it didn't remotely slow down my cancer, with my December PSA reading of 14.x and rising fast. They need to develop a way, a test, a scan, something, to determine if a patient would benefit from SRT, before men pull the trigger on it.

David in SC