BOB 46 said...
Balladeer:
The choices:
1. The radiation triple play.
2. Systemic treatment only (some combination of hormone therapy, chemotherapy, and immunotherapy) avoiding the negative aspects of radiation treatments, which includes the treatments themselves, the costs, and the side effects.
The choice between them may be affected by the presence or absence of metastasis.
I believe that many high-risk men with "clear" scans are metastatic, but don't concede that all are. I do not find fault with surgeons who behave as if all are. They can't tell the difference any better than anybody else.
It is my goal not to promote or discourage any treatment path, only to provide food for thought.
There is no reason that the choice that I make without the-information-that-is-needed-but-cannot-be-obtained should have any influence on anybody else.
Bob,
I'd like to again express my warm and sincere thanks to you for your participation in this thread and for the infomation you've shared here. Its been a lively, spirited discussion, about
an extremely complex subject that has significant ramifications for everyone involved. To be clear, I never once perceived your expressed opinions as an attempt to influence me or others into any one particular treatment path. Not at all. Your sincerity was clear to me from the outset and I'm grateful to you for that.
On the very day that my urologist first announced the biopsy results and high-risk diagnosis to me, he said the following . . . "chances are, the events that led to this (meaning the tumor and the cancer) began ten or more years ago" and that it was "well underway long before the PSA or any other indicator would have even been detectable."
I don't know how true those two statements are, or if true, what their implications might be to the past and/or present timeframe of distant metastatic processes, but it helps underscore how ridiculously complex and frustrating this miserable disease is. On the one hand, most 'high-risk' folks lack a localized 'surgical' option due to the potential for undocumented or unsubstantiated mets, and on the opposite side of the coin, I suspect we'd all lack a systemic option like chemo or immuno (from an MO) without firm and reliable evidence of such mets. That would seem to leave only radiation. And when radiation experts then cite the relevant statistics, the indecision slowly erodes and your future treatment path is established more-or-less by default.
Could I now go and obtain an Axumin, C-11 Acetate or even a PSMA PET scan, and learn that metastatic disease is in-fact present at some level? Sure. If the results were in-fact 'positive', would it significantly change my RO's proposed triple-play (radiation) treatment plan (like it apparently did for Steve's RO above)? I have no idea - something I'd surely need to ask. But its also worth noting that in order to obtain such an advanced scan, I would have to furtther postpone treatment (i.e., Lupron), and further, that the first (Brachy) phase of my proposed treatment plan, isn't even scheduled to occur for 90-days yet. So even if I were to obtain such a scan now, who's to say what state of metastasis would be present then, relative to now? All I know with any certainty is that if the reported results of that advanced form of PET scan were 'negative' (like all previous CT, bone and PET scans have been in the past), my RO's proposal for triple-play treatment would positively NOT change. So, as I see it, my own collective circumstances have left me with no real choice other than simply playing the odds.
Anyway, thanks again, Bob! And best of luck to you in all that you do. I hope the future holds good things for all of us on this discussion board, and for all men afflicted with this disease worldwide. I'll continue to pray for that each and every day.