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Posted 4/4/2017 1:37 PM (GMT 0)
Gentleman
A new guy to the board with questions. I'm a Gleason 3+4(7), seven years after DaVinci with a .238 PSA biochemical recurrence. I'm 72 in pretty good health. My urology surgeon offered that if I was 60 there would be no question but to do SRT. I have looked at the Sloan Kettering nomogram as well as the Johns Hopkins Discovery publication and can't figure out the vast difference of opinion on life expectancy between the two. As a intermediate pt2c with a 17.7 PSADT does anyone have a opinion on life expectancy? I 'd rather not do the SRT with it's complications if possible. My older brother went through a similar program and had difficulties. Are there places/things to ask on this site to uncover additional information? Thanks!
Posted 4/4/2017 2:32 PM (GMT 0)
So you recently had a .238 PSA test score.... When was the last test before this one and what was your number?
Posted 4/4/2017 3:39 PM (GMT 0)
6/2016 was .151. I've had PSA tests about every 6 months that stayed>.008 for three years after the prostatectomy. It's been erratically moving up since then.The Sloan Kettering PSADT nomogram suggests 17.7 months.
Posted 4/4/2017 3:58 PM (GMT 0)
Another way to think of SRT is that it might yield an extended period of progression freedom from the disease. In my case it has bought me nearly five years without treatment of any kind. That will probably end sometime in the next year, but I have enjoyed five very good years. It may, emphasis may, keep you away from embarking on HT for quite some time. (HT comes will significant side effects.) Best wishes!

NewspaperLover
Age 73
Gleason 8
2009 surgery upstate NY. Failed in 18 months.
Moved management of my case to Memorial Sloan Kettering in NY CIty.
2011-12 HT +SRT.
PSA undetectable for nearly three years.
Jan 2015. PSA .08.
Jan 2016. PSA .26.
March 2017. PSA .56.
Still not undergoing treatment. Probably soon enough though.
Posted 4/4/2017 5:17 PM (GMT 0)
Your surgeon's reluctance to recommend SRT is understandable, and if I were your age I would avoid it if at all possible. I am still new to this site as well and six years your junior, but I would suggest that you consider short term ADT with the long range possibility of castration. The side effects of HT are far less profound than is bone metastasis and death. The greatest risk - assuming the regimen is tolerable and effective, is that the micromets will eventually become resistant. You could try intermittent HT, see how well your PSA responds, and ultimately opt for castration. IMO this would have a good chance of delaying metastasis for a period of years. The sacrifice is more a loss of energy and drive, which to some extent comes with age anyway, rather than bemoaning loss of sexual function. Ultimately you may succumb to some other disease before being faced with the possibility of chemotherapy for stage 4 PCa.
Posted 4/4/2017 10:30 PM (GMT 0)
doubling time can change. I would have done SRT a lot sooner but I realize you didn't and you don't really want to. SRT would have been much more desirable to me than ADT but I have the "luxury" of already having done two types of radiation as well as Lupron. good luck. hopefully you'll never have to do anything.

ed
Posted 4/5/2017 12:07 AM (GMT 0)
I had SRT at 75. I haven't had any issues until this year. SE's from SRT were hematuria and occasional stress incontinence. I am 80 now and my primary care Dr says I can easily make it into my 90's. If you are in good health and have a healthy lifestyle you have to believe you are good for at least another 15 plus years.
Posted 4/5/2017 1:04 AM (GMT 0)
I'm trying to understand what you looked at and what the nomograms told you. Here's the MSK nomogram that shows your life expectancy if you have no further treatment:

/www.mskcc.org/nomograms/prostate/biochemical-recurrence

Use this other nomogram to figure out your life expectancy from other causes. The nomogram is meant for men with newly discovered PC - which does not apply to you - just put in Gleason 3+4 and leave the rest of the PC info blank on that page - it doesn't matter. It will tell you your actuarial probability of dying from some other cause (ignore the PC mortality figures) at 10 or 15 years:

/webcore.mskcc.org/survey/surveyform.aspx?&preview=true&excelsurveylistid=4

Now, one last nomogram. This one will tell you the probability that your PC can be successfully cured with salvage radiation:

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html

That should give you a handle on how much longer you'd live if you got salvage radiation. What they won't tell you is what the side effects of SRT will be for you. Considering the long recovery time since your surgery, you can reasonably expect milder side effects.
Posted 4/5/2017 6:01 AM (GMT 0)
Goldenyears....You know what to do or not to do in this situation...enjoy your life...put this crap behind...turn the corner...run don't walk...you ain't gonna die from prostate cancer....which brings me to a question...what is the difference tween dying from Pca and dying from complications of Pca cancer...
Posted 4/5/2017 11:51 AM (GMT 0)
Welcome.

There are side effects to all treatment for prostate cancer at this time. Doing nothing also comes with a price.

There are lifestyle choices and medications that can improve your dealing with the treatment side effects. Not all of us experience the same intensity of side effects.

Your task is to learn as much as you can about all of the options, then make your best choice. It is not so much age, rather, it is your overall health, fitness and emotional strength that matters.

I had a trail friend who got brachytherapy for a bothersome PCa when he was 87. Yes, the side effects bummed him out for a while, but those passed and he made it to 94 years old in relative comfort, died peacefully in his own home with a big smile on his face. smile
Posted 4/5/2017 4:26 PM (GMT 0)
Yes but could he have made it to 95 without the treatment?...just being silly...but it does illustrate the meaningless of time when it comes to death...to me...there is only life... happy trails to you...untill we meet again....sayonora... vaya con dios...and all the sentiments of that truth...Im sure every culture has a phrase that expresses the same...there is some thing to that fact...which comforts me...

Off to a piddling swell south shore...but the sun is up the tide is right...I don't argue wid da light..
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