Possible biochemical recurrence.

John was in your position when he was almost 52 - okay, he hated bical but it was only for 6 months, it didn't stop him playing rugby or cycling or going to the gym and here he still is, with a PSA of 0.1 ten years later.

Some people find the bical side effects more distressing than ADT, others find the opposite. It isn't ideal but as a young man, your focus might perhaps be on getting to be an old man?

Not sure if the formatting of this sit appears weird for everyone, but my earlier response seems not to be in order.

The onco is talking bical oral for 2 years.

He played down sides and said that I would maintain a sex life. You, however, suggest that John had a rough time.

Which of the many stated sides did John suffer?

Edited by member 28 Sep 2021 at 08:04  | Reason: Not specified

The letter stressed the importance of 0.2 being the trigger for salvage therapy and that this is based on data from the Radicals trial that shows no benefit to going any earlier. So it looks like the original choice many years ago of 0.2 for BCR has stood the test of time. When I see my usual Onco in 8 weeks (the one who recommends treatment before 0.1) I will ask him his opinion of the Radicals data. I will also ask him why he recommends prostate bed + lymp but the RM said probably prostate bed only unless the scan shows lymph involvement.

Re scans both my Onco opinions recommend a PSMA scan but acknowledge it may not show anything.

I am not yet persuaded that "survival at any price" is the correct course of action.'

I guess a number of us wonder whether we did the best thing, particularly where our original treatment does not entirely eradicate our cancer. The surgeon who headed the MDT in my case told me he would remove my Prostate if I so wished but thought I would be better off having RT as he doubted he could remove all the cancer. I took that advise and for a couple of years or so the result looked good. However, a small tumour was subsequently located in my Prostate and I began to wonder if I had gone for surgery, perhaps supplemented by RT, I would have avoided the need for HIFU which now needs to be repeated. Of course all this is academic because we are where we are and speculation can make you upset about your treatment choice so really serves no purpose.

As to survival at any price, this will depend on the way the individual sees it and maybe personal circumstances. I am now a full time carer for my wife and she would not want to go into a home so perhaps my threshold would be further down the line than it might otherwise be, although I do naturally pusue treatment options to still enjoy some of lifes pleasures. Then I know what a rotten way to go death can be from PCa and the time leading up to it. Better to die of a stroke or heart attack or perhaps something else!

Ok, I spoke to the surgeon last week and he took my case to the MDT.

The consensus is that I should not have radiotherapy to the prostate bed and instead wait till my PSA breaches 0.2, at which point I get a PSMA PET scan.

Why? Because my histology suggests a 35% probability of metastatic disease. Blasting away at the prostate bed and chemically castrating me may only serve to make me miserable, without benefit.

To be honest, I have throughout favoured a "do as little as possible" approach and the above continues with the theme.

I asked at point did the cancer metastisise(sp?), he said pre-surgery because the tissue removed was margin negative. I don't know enough about the subject to know if that is absolutely guaranteed. Intuitively, I can see how it may not be.

What are the chances of it spreading as a result of the biopsy?

I ask because for some reason the surgeon who did it took 45 cores. One of the surgeons I spoke to about the RP commented "what the **** did he do that for?". I am aware that track seeding is a risk with biopsies.

Okey dokey, so here are the scores on the doors as of today:

21 Jan 2020 = 0.04

20 April 2020 = 0.04

24 July 2020 = 0.04

10 November 2020 = 0.08

15 December 2020 = 0.05

16 March.2021 = 0.08

15 June 2021 = 0.14

22 June 2021 = 0.13

15 September = 0.17

10 December 2021 = 0.28

That looks to me like the cancer cells are multiplying exponentially.

I have a referral for a PSMA PET scan next week.

Is that sort of increase to be expected, or should I insist that my wife buys one fewer Christmas crackers this year?

As I mentioned previously, there is a 35% chance that the cells are metastatic, apparently So there is a 35% chance of SRT to the prostate bed being a waste of time.

I am given to understand that at current PSA levels there is little risk attached to waiting for scan results.