Treat PSA or treat signs?

Howdy! I had CT Scan of the Pelvis and full body Bone Scan yesterday, back in the waiting mode, not worry mode, results 5th Dec. It is what it is.
Having said that, I started to think about the next step. If it come back positive, discuss treatment options, form a plan and carry it out. Pretty straightforward in my mind.

If it comes back negative I need to re-think my situation. Do we treat the PSA blind (not knowing the source) or do we wait for a higher PSA, re-scan, and re- assess treatment options.

My PSADT is hovering around 3 mos so there is something significant going on so waiting for a PSA rise to an optimum range for a Bone Scan will not take long, counterintuitive but.....
My Uro told me that the more poorly differentiated the cells the sooner they become hormone resistant so maybe goin on HT "blind" might not be the most effective course of treatment.

I guess it really comes down to treating PSA or treating a sign. My goal is QOL, within reason. For me, knowing what I'm dealing with really reduces stress and anxiety, I can accept reality but have a harder time with the unknown.
So what do you guys think? Wait for something to target or go in blind? I would just like to have my ducks in a row for the Uro visit next week.
Hate to say it but, here's to hoping they find something.

Cheers, Doug

Hi Peter, long time. Yeah I agree with the the further scans if available and will be a topic with the Uro. Neither myself or the Uro thinks it's local so SRT was dismissed. I've been thinking about the chemo and hormone cocktail for quite sometime now and again will be another topic of discussion.
With a PSA of 1.15 three months post op I sort of think I'll be playing catch up for a while. Me moving back to Canada caused me a 4 month delay in treatment which couldn't be helped, bad decision maybe but water under the bridge now.
According to my theory, I have more PSA producing cells in my body than I did when my prostrate was intact so something should show up soon. I didn't mention it above but after the initial full body scan, they came back up to my neck and shoulders and spent another half hour "checking something out" she said. Thanks for the input!
Cheers, Doug

I tend to agree that, with your high three-month PSA and with negative margins, it seems unlikely that radiation would be a lot of help right now, but of course the scan results could change that if they provide an obvious target.

Hi Doug,
I share your dilemma about when to start/restart HT. When it was clear that SRT had failed, my onc suggested a PSA range of 2 to 20 to initiate HT, in fact they had a study going to compare early vs. late start. I dreaded HT but with a 3 month doubling time I gave in at 9.6. CT and bone scans showed nothing at that point but within 3 months the onc would have been pretty insistent. After a year on HT and 18 months off my PSA was back at 9.8, treatment on again and scans clear again. After a second treatment year my second vacation looks like it will be shorter with last week's PSA at 2.2. How long to wait this time? Does 3 months one way or the other matter?

I have followed the HW threads with interest regarding more sophisticated scans being used to identify early lymph or bone mets with spot treatment potential, but my attempts to discuss this with my onc have so far been dismissed. I am treated like a slow fifth grader and I hesitate to invest the time, travel and expense to pursue this further at another treatment centre when it may well come to nothing anyway.

You are concerned, with good reason, about QOL on HT but it looks like it is unavoidable barring a successful sensitive scan and treatment as outlined by Peter. Whether delay or more aggressive treatment or something in between is the best option is for you and your docs to decide. The side effects of HT have been relatively mild in my case. I had already taken the big hits to QOL from RP and SRT: incontinence, strictures, ED, shrinkage, mental stress. The loss of the last of my libido in a disintegrating marriage didn't matter much and the hot flashes, fatigue and muscle loss were manageable. Maybe someone who has been even temporarily castrated saying, "Well, that wasn't so bad..." is confirmation of just how terrible it is, akin to a neutered tomcat sleeping away the day in the sun. Unlike the tomcat, however, we can recognize that sleeping our life away is a mistake and we can make conscious efforts to work, play, find a new mate and value what remains instead of lamenting what is gone. Its been a hard lesson for me to learn and of course, some days it still doesn't take.

Best wishes,
A fellow Canuck