SRT questions - can you help?

Dear HW friends

I am wondering whether you might be able to help me with some questions.

Firstly, TA noted in a recent post, that uros are often behind the eight-ball when it comes to being up-to-date regarding radiotherapy, and when to pull the trigger for SRT. GG’s uro says he will not refer him to anyone until his PSA reaches 0.2. This worries me as, by the time we get him in to see someone (especially if they’re any good), his PSA could easily advance beyond that. From what I’ve read, there is a fair bit of ‘prior’ work to be done, before commencing tx and I gather this can also take a fair amount of time. The guys on this forum refer to picking and choosing their specialists and ‘interviewing’ people for the job, but I’m wondering how I might be able to organise this benefit for my GG (if needed), without having to wait for his uro to decide ‘when the time has come’. I guess things are probably different there, but could he just go to a GP and ask for three or four referrals to different specialists? I’m imagining (perhaps wrongly) that his GP might baulk at this suggestion.

Secondly, if his PSA shows a rise at his next test in a couple of weeks, the fear is, of course, that he is harbouring occult metastatic disease. I say this due to his very high pre-op PSA and the fact he has a detectable, albeit low, PSA just one year out from surgery (with supposedly good pathology); neither being good portends. TA also pointed out this week, that very few recurrences are indeed local. If this turns out to be true, is there any point at all in subjecting him to SRT? I’m not sure a scan will pick anything up at 0.2 (or thereabouts), so we’d be literally just taking a shot in the dark. Is SRT ever delivered in this setting, or is it just straight to ADT?

Thirdly, and finally, if the decision is made that he is indeed metastatic, would chemo be a first/early option? And/or in conjunction with any other tx? I’ve read on a couple of other posts here this week, that docetaxel should be the first tx for mets; rather than waiting.

As always, I appreciate your insight and help with trying to get my head around all this.

Health and healing wishes to you all.

Jaybee (for GG)

Jaybee,
You have gone off the deep end with this. His PSA is 0.01 -- below what anyone in the world would use as an SRT cutoff. Take a deep breath. Read a good book (like mine!), and let it go. This isn't serving any useful purpose - just creating more anxiety for yourself.

And I did not say that very few recurrences are local.

Thanks TA! And my sincerest apologies - I must've misread that bit. Too much information for this befuddled brain!

I've just realised it came from a post re: salvage tx for folks who'd received initial radiation as their primary tx - so not relevant here.

Please don't misunderstand me - I'm not freaking out just yet - just trying to learn as much as I can so when the uro blows us off again, I'll be better equipped to respond. He poo poo'd the notion that anyone would ever be referred off to an RO until they reached 0.2, and that just wasn't/isn't my understanding.

Can't wait to read that book of yours and just OT for a second, did you know there's a new Kath and Kim coming out?!!

Post Edited (Jaybee&GG) : 7/25/2017 1:59:36 AM (GMT-6)

FWIW I have seen <.02 referred to as undetectable, or the lower limit of testing, and in cases of existing adverse pathology <.03 as the trigger point for SRT... but GG does not appear to have any. So I join the others here in suggesting that you relax a bit until several subsequent PSA tests might show a rising pattern.

J&D, I agree with your approach. Jaybee, I'm like you I want to be one step ahead (although I think it's still early and the jury is still out in your case).

So I took it on myself to contact a top RO in my area and make my own appointment. It too about 3 weeks to get him everything he needed before giving me an appointment, surgical notes, PSA history and the surgical slides. Then once he had everything I was given an appointment for about 5 weeks out.

By doing this and not waiting for my Uro surgeon to decide it's time to refer me, I saved 2 months leading up to 1st treatment steps, should I ever need it.

Jaybee, if you have the ability over there to self refer, I would do so, IF he gets another rise or two in PSA.

Jaybee&geegee-

You can count on me to get you as armed up with data as one can be if you ever need those arguments. There's nothing that won't take me more than a few minutes to accumulate and send to you, so there is nothing you need to prepare in advance. Enjoy the present moment.

OT- I love Kath & Kim! They tried an American version, which was funny, but really lost something in translation. At the time, I had an Aussie partner who translated the parts I didn't understand (linguistically and culturally) into American. I fully expect you to speed read Thaw's Hammer, and for your comment to be, "I liked it, but I don't agree." And don't forget to read the gossip magazines too, one must keep up with current events.

Beth, I'm a financial planner, so its not because I'm more like a woman . Althgough my hair does catch fire easily.

Jaybee-

Thanks for that kind offer, but they put in a region code on the DVD so that an Aussie DVD can't be played in the US, except on a laptop. I used to have an Aussie DVD player on which we watched the full sets of Kath and Kim and Summer Heights High. I can live stream it via Acorn TV (shows from across the Commonwealth) if I sign up for it

Jaybee, in looking for a competent RO, I like to see where they were educated, any awards they may have received, are they published, how involved in research are they, and of course, how long re they practicing. Also, that they are associated with a major institution with a comprehensive cancer program.

Not that they must have all of these requirements, but it's what I think is a guide to having reason to believe they are good,