That’s what it’s coming down to, or so it seems. Using the ultimate “executive decision-making aid” to determine what I’m going to do.
What brought this on? Another email exchange between me and my radiation oncologist.
Over the weekend, a few more questions popped into my head and I wanted to get his response. Yesterday, I fired off an email asking if any advances in radiation delivery technology or methods in the last 10-15 years improved the side effect outcomes over the studies he shared with me. In short, the answer was no—there were no appreciable changes.
Of greater interest to me was his interpretation of the Freedland study, which shows that I can do nothing and have a 94% chance of being around 15 years from now. His response:
I am familiar with the study you included, and it is one of many retrospective reviews on this subject. The authors preformed a retrospective review on a total 379 patients over period of 18 years from 1982 – 2000. Therefore, although the data are valuable and contribute to the literature, I consider it (as well as the many other studies on this subject) thought provoking.
Perhaps I’m reading too much between the lines, but his last sentence translates into “skeptical of the study” to me. He continued:
The bottom line is that you have a biochemical recurrence with a low, slowly rising PSA. Do you need radiation treatment now, sometime in the future or never? I don’t have a definitive answer to that question, but there are data to suggest “the earlier the better” and other data to suggest treatment might not be needed at all. It depends on your point of view…
Am I upset by that response? Not really. It’s pretty much what I expected it to be, and that tells me that my research has been quite thorough. He and I both landed at the same place.
Will it make deciding my course of action any easier? Hell no. But it does reinforce that it’s my decision, and my decision alone.
Now where did I put those Eisenhower dollar coins again???
Dan's Journey through Prostate Cancer 
So what do you do when the coin lands on its edge?
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Let’s see…. Sell the house, drain the bank account, and go on an around-the-globe adventure till I run out of resources???
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Your research has been very thorough. I would take into account that it’s likely the radiation oncologist has a tendency to want treat, all other things being equal. In your case all other things are equal, maddeningly so.
Do you know where the cancer is or is irradiating the prostate bed just a best guess? That seems a critical question to me.
I don’t know that my comments here help, but I wanted to speak out about what I would be thinking if I were in your shoes. I’m with you regardless of which path you choose Dan.
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All good points, Jim.
I agree… You go to a surgeon and he wants to cut. You go to a radiation oncologist and he wants to zap. It’s why they became what they became and how they earn their living. (Perhaps a bit cynical view and wrong to broad-brush generalize because there are doctors out there who will recommend treatment outside of their specialty.) I will say, however, that because this is an active duty Navy doctor at a Navy facility, the profit motive certainly is less, if not out of the equation altogether.
We don’t know definitively where the cancer is so, yes, we’d be zapping on a best guess/statistics. It’s a critical question to me, too.
Here’s a good article summarizing the current imaging technologies, and the table near the bottom summarizes their effectiveness at detection by PSA level. My last PSA was 0.11 so you can see that not much would be of use to me, and the R.O. wants to zap before 0.2.
https://pcnrv.blogspot.com/2016/12/pet-scans-for-prostate-cancer.html
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I feel for you, Dan. With all the research you’ve done it seems being right on the fence is the right place to be, but that doesn’t help at all. No decision is a decision. I hope you can make a choice that you will be at peace with.
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Have you looked into proton beam therapy? You are so thorough that perhaps you have. If not you might look on line at Loma Linda school of medicine; they have a lot of experience with it. and I believe both as primary and secondary radiation. As I see it proton irradiation has some distinct advantages… though I had a small early lesion and used the more traditional Stereotactic External Beam therapy. But I’m just beginning your journey, that was less than a year ago.
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Thanks. I have to admit that I really haven’t looked at proton beam as a salvage treatment option because my prostate is gone and we don’t know exactly where the cancer is located with my PSA level. I suspect that, given the accuracy of proton beam or even SBRT, you need to know EXACTLY where you’re aiming to zap the cancer cells. With IMRT, its a more broad-brush approach that, as you well know, tends to have worse side effects. Definitely something to look into, though.
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Yikes! For what it is worth I’m going to say if I were you, I’d flip a coin. But on the other hand I might wait and see. On second thought, I would wait and see what the future holds. How’s that for help? Sure do wish you weren’t going through this. The only thing I can think to say is it could be worse.
Steve
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Thanks, Steve. It does take it’s toll, and I am thankful that I do have time to be deliberate in making my decision.
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