HealingWell
Search Close Search
☰

What would you do?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 4/4/2022 3:04 PM (GMT 0)
My last PSA result came in at 0.19 7 months after IMRT salvage radiation. Up from 0.13 three months earlier. My URO doesn't want me to start ADT yet. He wants to wait until it gets to the point where I can have a PSMA pet. At 80 years old he doesn't want me to have all the side effects of ADT too soon. What do you think?
Posted 4/4/2022 3:16 PM (GMT 0)
The main reason you would do more scans is to find tumors that can hopefully be radiated. The problem is that by the time you find some large enough it is likely many more small ones will have developed. The scan with Pylarify is the most sensitive now, but you are probably borderline to show anything. What if you wait and the scan shows nothing? How much are you willing to let your PSA increase before doing ADT?

On the other hand, if you start some mild forms of ADT now you may be able to just try casodex for a while and see it’s effect. It normally has fewer side effects that a Lupron and others. You could also start Avodart, also with minimum side effects, to dampen the DHT. You will know if these are working if your PSA holds steady or reduces. If you do have to go on full ADT, you may be able to do intermittent therapy which will generally reduce the overall side effects.

I suggest you find a real good medical oncologist the specializes with prostate and get another assessment.
Posted 4/4/2022 3:24 PM (GMT 0)
Ed,
After failed RP/RT you're in the area of treatment where there are no clear guidelines that I'm aware of. Different MOs have different ideas for when to start ADT. Some MOs base the decision on PSA doubling time, presence mets on a scan (which is evolving rapidly with the newer sensitive scans) or physical symptoms. Some patients are uncomfortable knowing they have an increasing PSA and they may opt for ADT sooner than really needed.

Although I think this is an MO's job, your Uro's job plan sounds very reasonable to me.
Posted 4/4/2022 5:25 PM (GMT 0)
Good to meet you Ed,
I also feel your doctor has a reasonable plan. He appears to be concerned about your quality of life while considering the need for immediate treatment, and your longevity.
Posted 4/4/2022 6:47 PM (GMT 0)
Ed i would listen to your doctor. don't rush into ADT!
Posted 4/5/2022 12:40 AM (GMT 0)
While i also think your Dr is thinking smart, and i'd be happy that he is concerned about quality of life, i also think this is a very personal decision. Are you willing to say, "ok, I'm 80, I'll probably die of something else in the next 10-15-20 years, so why not wait and squeeze every ounce of good QOL that i can out of every day"? Knowing it would be coming at the expense of higher risk of mets?

Everyone is different. If you are one who would dwell on it if you did nothing, maybe thats not the right decision. And vice versa, if you could let it go, and not worry about it until your next appointment.

For that reason, i think it goes beyone medical decisions, to personal decisions. Its for you to decide whats best for you
Posted 4/5/2022 1:13 PM (GMT 0)
Thank you all, I this point I'll wait and see how my PSA progresses and hold off on ADT as long as possible.
Posted 4/5/2022 1:23 PM (GMT 0)
You can see my journey in my sig.
✚ New Topic ✚ Reply