Waiting too long?

Diagnosed in 1999 with PSA of 7 and Gleason 7. Recurrence in2006. Steady uptick and now PSA is 3.9.(11 years).My urol. says we should wait until PSA is at 7 or 8 until hormone thearpy. Would like to hear your suggestions/opinions please. Thanks, Ron.

If you could provide more details it would help. You can add details to a perrmanent 'signature' under your profile.
Generally, sooner is better for treatment of recurrences. Good luck.

Am thinking that HT will help you live longer.
You don't know if you are castration resistant until your PSA goes up while on HT. How long HT works varies a lot.

HT is palliative, not curative. Sadly.

HT and other chemo treatments will keep the PC at bay for a very long time. We have guys here 5, 10 years on various HT and other meds and they're still going.

The guys who know the advance disease better will be along soon with better information.

Andrew

I think it was a recent large Australian study that showed the earlier you start HT the better. Can't seem to find the link on TA's website but I think this is the same study.

www.cancervic.org.au/about/media-releases/2015-media-releases/june-2015/prostate-cancer-trial-shows-longer-survival-with-immediate-hormone-treatment.html

Post Edited (Gear) : 3/21/2017 3:05:18 PM (GMT-6)

Yes Gemlin, I think I found the same. Thanks Ken

Your PSA is still relatively low, but high enough that if any distant mets are present, it may show up on a PET scan. If the cancer is still local (and a low PSA is a good sign of that) you may still be cured by local salvage treatment. If it is distant, hormone therapy is a better option. about half of recurrences after radiation are local only and may still be curable:

/pcnrv.blogspot.com/2016/08/site-of-recurrence-after-primary.html
/pcnrv.blogspot.com/2016/09/most-of-recurrences-after-primary.html

If you are near Atlanta, you can possibly get a fluciclovine PET scan at Emory (contact David Schuster there). It is FDA-approved, so Medicare may cover it, but check first.[url]

Ron,

Welcome to the forum! Sorry you have worries but glad you found us. Hope we can help.

Usually, as I recall, "recurrence" for guys who had seeds or other radiation is higher than for those who had surgery. Some doctors call it with two consecutive readings over 1 ng/mL, others look for a rise to 2 ng/mL over the nadir value. The exact criteria are all over the map but they tend to be in the PSA 1.0-2.0 range. This suggests that in six years (between 2000 and 2006) your PSA dropped to some nadir then rose to 1.0 or 2.0 ng/mL. It also means that in the 11 years since your recurred it has only gone up by 2 or 3 ng/mL. That's quite a slow progression. It doesn't seem to me that you need to be in a hurry to decide what, if anything, to do about it.

I think others have answered your question about the success rate of HT but just to be sure, hormone therapy for systemic disease is not intended to cure the disease, just to delay its progression. There is no bright line called "success" that you can use to work up percentages. Its effectiveness is measured in terms of the average number of months, or years it adds to the period before the disease causes various problems.

Which leads to another question: How old are you? Because your disease seems to be so slow moving your odds are fairly good that you will be able to grow very old and die of something else before your prostate cancer causes you any problems at all. Obviously, the younger you are, the more likely you are to live long enough for your prostate cancer to cause problems.

Update: I was interrupted while typing my comment and Tall Allen posted before I submitted. His advice about additional scans to decide what approach to take is good. He knows a lot more about salvage opportunities for men in your situation than do I.

Get a scan but understand not all are the same. Some like a fluciclovine PET are much better.

Seeing my urol. tomorrow. Will keep you posted. Thinks to all for your advice. I am 71 years old. Ron.

RonC
Like many of us here you have arrived at a point where there several possible paths to take and no clear-cut guidance.

I'm linking a paper below from 2012. It can't tell you what to do, but it does illuminate the pluses and minuses of your choices. It discusses early vs. late start to androgen deprivation therapy (ADT); continuous vs intermittent ADT, Lupron vs bicalutamide, quality of life issues, etc. While it can't give you definitive answers, it does give an overview to what you need to think about and discuss with your doctors. You will see in a couple of places it discusses slow vs faster doubling times and the presence or absence of high-risk features such as seminal vesicle invasion or extracapsular invasion and how these might influence a decision for earlier or later start of treatment. I hope this helps.
Jim
www.hematologyandoncology.net/files/2013/02/ho1112_bruce1.pdf