My husbands recent diagnosis of advanced prostate cancer

I think with T3a and one or two lymph nodes involved, you will have to accept that some cancer will be left behind by surgery, nerve sparing or not. The RT will be required to sweep up what is left.

I will try and give you an analogy. Think of the nerve bundles as the wooden branches of a tree, and think of the leaves as cancer cells. So this tree is a bit weird, as I'm saying it is completely healthy if it has no leaves, you will have to bare with me on this one. If the surgeon spots leaves on this tree he will have to cut it down, OK you might be lucky there may only be leaves on one side, so you will have partial nerve sparing. 

Now think of RT as the Mother of All Hurricanes. It is going to blow through that tree and strip out all the leaves, you may lose a few small branches as well. If you are unlucky one or two leaves may survive and if that is the case then you still have cancer. 

Now I think you have no choice than to have RT whether you have surgery or not. So that hurricane is going to be blowing through that tree, and it has a high chance of stripping all the leaves. Sure the surgeon can definitely chop the whole tree down, but he may leave some leaves elsewhere so you need that hurricane whatever.

Not a perfect analogy but I hope you get the picture.

Now I would argue that if you are having RT anyway, forget the surgery. RT alone may do the job. Alternatively I can see a strong argument for saying well let's get rid of as much cancer as possible because the prostate is pointless if you don't want children and if you remove that pointless gland and all the cancer in it you only have to worry about the cancer which has escaped. The problem is the damage done in pulling the prostate out, and if the RT has a good chance of killing all the cancer why take the risk. 

Though I am happy for everyone on this forum, unless someone is ten or fifteen years post treatment take their success story with a pinch of salt, that includes me I am only one year post HT. Anyone with my diagnosis has a 98% chance of surving prostate cancer for five years anyway. Rather than celebrate my prostate cancer survival I should be celebrating not having a road traffic accident as I was more likely to die from that than PC in the three years since diagnosis. 

You're right some urologists are a bit miserable, but I think I would be if that was my job. 

Yes, I live just outside Glossop, I had treatment at Christie's. I probably remember the names of the miserable urologists but we won't discuss them here. Do you live near by? I am not averse to having a chat over a pint of beer.

Hi gaz, just spotted your post as I was typing, thanks for the vote of confidence, and for acknowledging, we can only talk about success of treatment to date. We don't know the future, but if your an optimist like me no reason to think anything will change. 

Yes, once you have made a decision it is such a relief. Turning that M1 in to an M0 was the best thing you could do. It has taken your OH from guaranteed HT for the rest of his life, to treatment with curative intent. A cure is always a tall order, but postponing the disease by fifteen years is just as good in a 73 year old, and even five years is not a bad result. So let's hope things all go well. The Christie have RT machines set up in Oldham, so you won't have far to travel, it's not so easy for people who need to make 100 mile plus round trips for 20 treatments.

Have a nice few days away. 

That is a good score. The definition of undetectable is confusing. Strictly speaking a number with a < in front means below the limit of the machine used to to test it. So if a hospital bought a really old testing machine which couldn't measure PSA below 10 even your husband's original PSA of 8.2 would have been reported as <10 and hence on that machine it would have been classed as undetectable. Of course such a machine would be useless and whoever bought it should be sacked. About 20 years ago test machines were able to measure down to 0.1 so anything below that was <0.1 so undetectable. Newer machines were introduced capable of measuring down to 0.03 so on those machines undetectable was defined as <0.03  these machines can be described as ultrasensitive. 

The problem with ultrasensitive PSA tests is that they pick up tiny amounts of PSA created by adrenal glands so even women would have a detectable PSA. So now some hospitals have gone back to reporting anything below 0.1 as <0.1 even if they know exactly what the number is, to avoid stressing the patients. So your OH's PSA at 0.083 is delightfully low, and if it had been reported as <0.1 you would have been very happy. At his next test it may be 0.085 and that may cause some anxiety, but again if it were reported as <0.1 you would be happy.

All of my PSA tests whilst on HT were reported as <0.1 . I presume the hospital I was under had modern machines capable of reporting to two or three decimal places but they chose not to, as there is no point in having patients worry about an increase of 0.001 on a test.

The only time reporting to more accuracy than 0.1 may be relevant is for someone who has had a prostatectomy. A change from 0.03 to 0.08 might be a cause for concern. But for someone with a prostate on HT anything below 0.5 is good, particularly if it is falling staying the same or only rising slowly. For someone post RT and no longer on HT a figure under 2.1 is good again as long as it isn't rising rapidly.

So your OH's PSA of 0.083 is to all intents and purposes undetectable and if in three months time he is still on HT and it is still <0.1 it is still to all intents and purposes undetectable. All undetectable results should be celebrated so get down the Christmas markets and have a mulled wine.

Interesting paper on PSMA scans after HT initiated, it looks like HT may actually increase the sensetivity of PSMA PET scans.
https://link.springer.com/article/10.1007/s00259-019-04529-8

Regarding the <0.1 result after HT but prior to treatment that is a very good indicator so all good news..

Edited by member 24 Nov 2021 at 09:56  | Reason: Not specified