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Hi Allen,
I had a read of your profile, and yes, you have done very well over all those years. No question you do have a recurrence but hey the velocity is very reasonable and much in line with your previous history. We need to bare in mind that PSA is an indicator, but not definitive, and subject to variations extraneous of progression. The pet scan result was encouraging but micro mets could still be lurking. I suspect you are several years away from a definitive diagnosis of clearly identifiable tumour/s. So what to do? Well were I you (which I am by the way), I would be inclined to look at my quality of life, variations to it that a therapy may have, and longevity issues associated with early intervention v late. Now I am loathed to cite research without a reference, but from my past literature reviews (admittedly dated by several years now), early intervention, therapy wise, do not provide a meaningful bonus in longevity.
I am 13 years out post EBRT for a Gl 7 (4+3), T2a, psa neo adjuvant 6. So I was right on the border of moderate/severe. But like you I did very well and it was not until the last 3 years that my six monthly PSA begun it's upward journey. I am currently 1.2. My velocity is fluctuating between 2 to 3 years. Like you I will be having a psma pet scan when I get to 3, probably in two years. But I suspect that the excerise will be more academic that diagnostic. And don't forget that I still have a prostate, also sexually active, albeit constrained by co-morbidity. So in the meantime my daily goal is to enjoy every one. I suspect in all likelihood we will be having the same conversation in another five years Allen. And remember if and when we progress, the second and third line therapies of today are vastly superior to those of yesteryear.
Just like my old mate Don O, I am also a YANA survivor, and guess what Allen, you are 2?
P.S. I forgot to mention that I had 9 months of Lucrin (Lupron in the US), that transformed my body with some lovely breasts, and a bit psycho with bad mood swings, and of course not withstanding the night time sweats. Not something I would relish doing again anytime soon.
John, thanks for taking time to reply to my question. And thanks for the thoughtful response. I have another PSA this week and, as always, will wait to see if that adds any insight into my decision making.
