Doug,
I added a recommendation to consult with Andrew Loblaw at Sunnybrook.
One doesn't just guess that there are metastases, one looks for them. I agree that there's no point to salvage radiation if there are bone mets, but you have to find that out for sure first - you can't just guess based on high PSA. Some cancers churn out a lot of PSA, some don't.
The first step is usually a bone scan, but that probably won't show a thing until your PSA reaches 20 or if it's doubling fast. I'd be understandably nervous about
waiting for a large PSA rise. On the other hand, if a met shows up, you know what you're dealing with.
Then there's a NaF18 PET/CT scan - that will find mets even when your PSA is above 2, or rapidly increasing. There's a place right there in Hamilton that offers it - Hamilton Health Sciences Corp.
For even greater accuracy, there's a very interesting imaging study in Ontario that you may qualify for. It uses a PET indicator called F-18 Fluorocholine and combines it with an MRI (instead of a CT) for very accurate localization. They are doing it in London, ON. Here are the details:
clinicaltrials.gov/ct2/show/NCT01804231May I suggest you
don't keep your mouth shut. It's your life, your health, your responsibility - not his or anyone elses. You have every right to question and make requests. Most doctors actually prefer shared decision-making to the old paternalistic model. I think you'll also feel better to be actively engaged, rather than as a passive victim.
- Allen