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Terry, maybe I am not making myself clear but the point of the arguement is once a patient has has radical surgery as Steve did and then radiation whether it be 4 months or 2 years later, PSA readings simply cannot bump because there is no prostate which causes the bump. My claim is that since his PSA is going up and although current readings are miniscule, in all probability it is on the climb, and not a bump (that being impossible as he lacks a prostate gland). It may take a year, or longer, to get to a point where it triggers his oncologist to order all the tests, i.e., chest X-ray, bone density, MRI and a C-Scan to determine a bench mark and start ADT. In my case it took from 12/08 (4months after completion of radiation) to 9/11 before I started Casodex with a PSA of 22. Yes, he should follow his doctor's recommendations and make his own decisions, and I do agree with the "Golden Rule" as I have had my share of curved balls thrown, but I cannot understand people trying to defy current medical understandings of this disease based on hundreds of thousands of cases treated by the medical community worldwide.
The range of treatment to patients with a PSA of 31 was based on several thousands of Hopkins patients.
The doctor there said several of his patients had PSA's above 200 without metastisis, and without any treatment other than quarterly checks. I did not get into how many in this group, that group, etc, as this is information probably shared by the professionals at medical conventions. I understand you questioning it but perhaps now, even if we all had the correct information we could not decipher it and come up with a conclusion.
My vision is to concentrate on all the progress being made every day to conquer this disease based on the latest information, and hope that soon a cure will be made available to all of us.
Jack I am not arguing if you are 'right' or 'wrong'. There is no definitive agreement on this aspect of this complex disease. But please read carefully what I said to Steve. I'll repeat it again here, slightly edited for clairty:
Were you given any specific reason for the suggested delay in starting ADT? The only thing I can think of is that your doctor might be thinking that what you are seeing is a radiation "bump" which sometimes occurs about two years after radiation therapy is concluded. ...You might like to ask him this and then weigh up the probabilities/consequences of your options.
I didn't know why the doctor suggested that the rise was not important: I had no access to Steve's medical data: I was saying that he should clarify the question with the man with the qualifications who suggested the delay.
Turns out that the delay was being suggested to delay the 'inevitable onset' of hormone refractory disease.
I do not accept that all disease becomes hormone refractory although there is no doubt that some does.
I have an open mind on the subject of whether PSA, a non prostate cancer specific test always truly reflects that it is only prostate cancer that triggers small increments in test results after surgery plus radiation. There may well be other causes that are not clear because there are no studies that look at this specifically, but that is by the by and I won't argue the points you raise because that was not the point of my post, which was for Steve to discuss with his doctor what his doctor's thinking was.
Jack,
After having my prostate out I was shuffled over to a radiation oncologist who gave me the standard radiation treatment. He told be to expect a bounce at between 1 to 2 years from the prostate cancer cells going through their final death throes. He expected my PSA to go up from .01 to about .1 during the bounce. If it keeps going up then it is not a bounce but recurrence.
