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Everything in PCa is totally controversial and leaves us guys in a vacuum of decision makings. I presume you know of Dr. Scholz, Lam, Sartor, Strum, Myers, and some others whom view treating a psa before the level of 10-ish and the reasonings probably along the idea of suppressing the PCa cells population and perhaps earlier is better. Might not want those sob cells setting up shop. Remissions in patients vary greatly while on these drugs and the duration time is a good clue as to how your future control will become. The averages on LHRH agonists is approx. 17-24 months or so, however this can be a bell curve and some guys have super long run on such, same for other drugs. I failed ADT3 control within 24 months (slow escalations), went to DES 1-mg regained total control and stability for about 8+ years, until more recently (I also have super high risk stats and lousy prognosis from early 2002). I am onto some other protocols, some gave short term results in months and now onto another one which may render some nice results, soon.
The reasons for earlier intervention might be to avoid possible micro mets or mets showing up somewhere, of which spinal, femur, hips and such areas can lead towards debilation perhaps (can be radiated once known sites as found). Nobody wants to be a debilated person, spinal fractures are possible in patients and longer term useage of LHRH drugs rob some bone density, thus useful to assist your bones with either other drugs for bone density, estradiol type drugs (patches especially easy to add to HT), maybe even D3 and other supplements.
If you have never read Dr. Fred Lee's PCa story it is amazing, he is 33+ yrs. as an incureable patient, still living and working in his old age. He never used the traditional HT drugs either. Google search his story it the links starts with: wwww.rochesterurology######### (he shares an office with DR. Bob a urologist in Rochester, Michigan). He has long term durable remission......it is possible apparently. Dr. Snuffy Myers is another interesting case of a doc with PCa and so far winning and tiger blood (lol).
Each case of PCa can be unique to some degree, since it is your once in a lifetime shot at how do you treat it....what do you do??? Do you leave it all for one doc to handle or do you get envolved in your own epic battle to some decent degree??? Do you look outside the limitations of the 'box' and question things or do you believe the so called average experts as knowning all there is to know on treating your particular case??? The experts and the real ones I mentioned may not agree on every little detail of treatments on the same patient. I admire those guys too, but that is a pretty big clue as to are we still practicing medicine to some real degree.....yes we are is my opinion.
At lest two of the good doctors you mention support AS (Active Surveillance) in principle in appropriate cases - low PSA being one measure. I have never understood why they inist that 'earlier the better'; 'treat as soon as PSA shows it's head' is appropriate in one set of circumstances but not the other.
Surely Strum's mantra ASSESS STATUS BEFORE DETERMINING STRATEGY applies in all circumstances, not just on initial diagnosis?
Gosh Bob, what a thoughtful and informative posting. I am going to clip it and store it and it'll be a valued resource if I find myself with those sorts of issues in the future.
My husband is in a similar situation. He had his surgery in 2004. His psa at that time was only 4.2
The final pathology report showed that both seminal vesicles were involved and he was diagnosed as T3B.
His psa stayed down for about one year. Then he had 32 radiation treatments. Again he did OK for about 2 years. Then the psa started to climb again until it reached 1.2 It stayed there fro several years. Last June it began to climb again. He has it checked every three months. Last one was in March and it was 3.2 Both his urologist and oncologist are holding off on any other treatment right now. He had a bone scan last month which was negative and he feels good.
I am a registered nurse and I read as much as I can about PC. There are many different opinions. More than looking at a number (10) both of John's doctors are watching his doubling time.
YANA is a great site.
Best of luck to you.
