The UCSF "CAPRA" Score Table & prostate location. CAPRA predicts the likelihood of a cancer's recurrence, metastasis and the risk of a patient dying from prostate cancer. The greater the point sum the larger the risks. (Source: UCSF document on 'Brachytherapy for Localized Prostate Cancer'. )
Within hours of posting the results of my post gall -bladder surgery follow up check (declared "golden" by the surgeon) my primary physician called and left a message about wanting to refer me to the Urological Associates here in COS. This is because the last test - 3 days ago - had disclosed a PSA spike of 2.23 ng/ml to 6.0. I immediately phoned her office back and said that I preferred no specialist referrals at this time, certainly until after I had contacted my oncologist at UCSF (San Francisco).
Even with that contact I referenced the work on salvage therapy by Dr. Kent Wallner, see e.g.
And also that I was prepared to wait further (given in some cases the post-brachytherapy PSA doesn't finally come down until after 5 years.). In any case, I told him I do not plan on having any salvage therapy whether that be surgery, or further radiation or god forbid anti-androgen therapy. The latter is a nightmare for the men who have it, diminishing their physical capabilities, as well as mental and emotional. As I told Janice, I'd rather live another 3-5 years with my mental faculties intact (including not suffering from depression or having to take anti-depressants) than live 15 more years as a mental, physical and emotional vegetable. (Another alternative in the mix is to have another PSA test, the "free PSA". Studies have found when it's less than 24% there is almost a 90 percent chance the cause is cancer or in my case, returned cancer.)
I know my primary doc, however, is an over-achiever and alpha female committed to "perfecto" stats for all of her patients. (Well, she was at least happy my a1c - approaching diabetic levels at 6.3 five months ago - has gone down to 5.5. because of rigorous exercise and avoiding all sweets, sugary stuff) But as I made clear, no more needle biopsies especially given the residual scar tissue from the high dose (1920 cGy) Brachy radiation, and after just having had a gall bladder surgery. No further biopsy referrals unless based on the new fusion-guided method, e.g.
This, as opposed to the standard needle biopsy (which I had in July 2012 - see my post then) which is antiquated by comparison. As noted in the Scientific American Handbook on Prostate Disorders (by H. Ballentine Carter, M.D.):
"Standard biopsies often detect indolent or inactive tumors, that won't spread beyond the gland and become deadly. More worrisome, first-time standard biopsies miss up to 35 percent of dangerous tumors that require treatment."
The UCSF document (Brachytherapy for Localized Prostate Cancer) notes that: "The biology of the cancer makes it likely to recur even after the best treatment." It adds that the cancer "may also change into a different form, say from an adenocarcinoma to small cell cancer".
And if the worse comes to the worst? Let's say I do get that fusion guided biopsy and it shows the cancer is still relatively localized. Then I will adopt a "wait and see" approach rather than rush into anything. If, however, it has metastasized from the original four localized areas and is ready to "burst the capsule" I will have to consider options available - so long as those options don't radically degrade life quality.. I'm also ok with doing nothing, as long as I can get a few years of life quality and critical organs aren't threatened - or there's a chance to prevent invasion of lymph nodes. All other factors being equal I am ok with a few extra years of quality life as opposed to 12 or 15 of not so great quality.
Heck, I have revised my living will and am now in the process of revising my existing last will and testament. (Which, btw, every sensible American ought to have unless they want the state to grab everything!) Death does not terrify me, and in any case there are much worse outcomes - maybe living longer but developing Alzheimer's disease as my mother did. She lived to be 91 years of age, but the last 15 were mostly survived in a haze, with her unable to acknowledge where she was, or what she had just said five minutes earlier.
In the end, it's all relative and we each have to pick our own terms of surrender ...or not.
See also this informative site on dealing with biochemical recurrence: