This year, as I notified the doc in my recent Medicare assessment, I decided to get no more PSA testing. The last result back in September showed it had gone up to 6.9 and at the velocity disclosed, it would be near 8.1 come this fall. Given I've already had two major treatments - one primary (high dose brachytherapy) the other salvage (focal cryotherapy) and plan no more - there's no point getting any further PSA tests. Also, that means the only option left to do anything is hormone treatments. However, the doc assured me that given this cancer is "likely slow growing" the odds are I will croak of something else.
Still, if complications arise, say bone metastases - e.g.
Or urinary-bladder blockages, then it would be time to go on to a hormone therapy regimen. This is the advice of Dr. Patrick Walsh a urologist at Johns Hopkins, in his book Dr. Patrick Walsh’s Guide To Surviving Prostate Cancer’
Therein he wrote (p. 338):
"If you have metastases to bone, bone pain, or a large mass of cancer that is obstructing your kidneys or bladder, you need to start ADT right now. In this situation it's the right course of action - one that can make a huge difference in your quality of life and can protect your body from the ravages of cancer.
But what if you have no cancer in your bones and no sign that anything is wrong except a rising PSA level after surgery or radiation - or the presence of cancer in your lymph nodes- and you feel fine? Many doctors would advise you to start hormonal therapy as soon as possible. Others - and I'm in this group - believe that in most cases there is no evidence that starting hormonal therapy immediately, as opposed to later, will prolong life.
Hormonal therapy does two things: it stops cells from making PSA, and it shrinks the hormone sensitive cell population. Thus, a man's PSA falls and it takes longer for his bone scan to become positive for metastases. But it doesn't stop the clock. The hormone insensitive cells keep right on growing silently."
The last sentence makes an important point, and as Dr. Dr. Walsh goes on to elaborate:
“A drug or hormone therapy that targets only one kind of cell won’t have any effect against another variety so the one size fits all approach doesn’t work here. Plus some of these cells have learned to be resistant and to grow in the absence of male hormones…so the drop in PSA may be misleading. These are called androgen independent or androgen sensitive cells.”