While I have just joined this site and am grateful to have found it, I am no stranger to prostate cancer. I would sincerely appreciate any input regarding my situation, but first, my history.
PSA of 4.1 led to RP six years ago at age 57; T1C; Gleason 3+3=6; seminal vesicles, vasa, apex, and base all free of involvement; margins and lymph nodes (5) negative; AJCC pathologic stage T2, NO, MX.
PSA of .42 3 months ago; PSA of .85 1 month ago; CT and bone scans both negative; referred to radiation oncologist for possible IMRT.
I continue to read all I can find regarding my history and so far have discovered the following:
• 25-40% of men who have a RP will have a biochemical failure/recurrence.
• IMRT should be considered for all with biochemical failure especially those with positive margins.
• Only half of patients treated with SRT have a long term PSA response to SRT.
• One study says that 60% of patients will have an undetectable PSA post SRT.
• SRT initiated more than two years after recurrence provided no significant increase in prostate specific survival.
• Patients with positive surgical margins are more likely to benefit from SRT.
• PSA doubling time is significantly associated with CSS, however, the risk of dying is not fully explained by PSADT.
• According to the Sloan Kettering nomogram predicting response to SRT, I have 1 chance in 3 of being progression free after 6 years.
Given the above, I am struggling with moving forward with SRT. It is aggressive, expensive (I have a high deductible insurance plan), not without significant risk of both incontinence and impotence (I have neither), and it is without a proven survival benefit. Yes, I can choose to zap my prostate bed and pelvis with 37 blasts of radiation, however, the question is should I. I must also add that while my oncologist (MD/PhD) might be brilliant, he has absolutely no personality and spent the better part of my consult trying to “sell” me on going forward to the point of asking me to sign a document to begin treatment. He was taken aback when I said I wanted to think about it. I realize health care is a business and I have enormous respect for the medical profession, however, I wonder what would happen to these guys if we found a cure for cancer?
If you would share your experience and thoughts, I would be extremely grateful.