This is Dr. David
thank you for your question.
your husband's prostate cancer is high risk.
the best data for long term hormone therapy and radiation therapy to the prostate cancer comes from Dr. Bolla from europe.
5-year clinical disease-free survival was 40% (95% CI 32-48) in the radiotherapy-alone group and 74% (67-81) in the combined-treatment group (p=0.0001). 5-year overall survival was 62% (52-72) and 78% (72-84), respectively (p=0.0002) and 5-year specific survival 79% (72-86) and 94% (90-98).
there is no "optimal" PSA at this point of 0.2. everyone is different.
he just needs to continue on with androgen ablation therapy for 2-3 years. better 3 years total.
after radiation therapy there is a lot of waiting and you can feel helpless to fighting the prostate cancer.
PET scan will be negative at this point and will not be beneficial.
he should work on protecting his heart and bones with no testosterone in his body by exercising regularly and working out and making sure he doesn't gain too much weight
with no testosterone in the body, it is easy to loose muscle mass and gain weight.
there are no signs now that his cancer is not curable.
the purpose of this long 2-3 years of androgen ablation is to freeze and make dormant any rogue prostate cancer cells which could have escaped his prostate and allow time for his own body's immune system to hunt them down and kill them.
so boostering his immune system, getting him exercise and a good diet and plenty of sleep and drinking lots of fluids all help his immune system to function properly.
there is no way to know when his prostate cancer started
let me know if you have questions.
Thank you very much for this response.
Thank you very much for this reponse.
you are welcome
did you see my whole reply above?
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Hitting the send before being finished! Are there tests he should do on ay regular basis for his heart and/or bones? He sometimes feels that his ankles are achy? And I am aware that Hormone treatment can play havoc with bone density. And yet I am amazed that NHS is not providing any follow-up on this. Hence our wish to be pro-active. Next question is assuming that he fares well with hormone treatment till Dec 2015 i.e. no "resistance" can we ask for an extra year of hormone treatment? Even if this means paying for it privately? When would a PET scan show a truth of what is? Thank you
low testosterone can cause joint aches and pains.
for men, low bone density is usually not a problem like it is for women after menopause. because men have testosterone after age 50 while women loose their estrogen.
so a few years without testosterone is usually not such a big deal.
you should show them the Bolla trial I gave you, that is really the standard of care for gleason 9 prostate cancer.
the NHS should pay for 3 years of hormone therapy.
PET scan would be negative now and not be helpful and would just be expensive.
I will look at the Bolla trial . At which stage of going forward would a PET scan be indicative of reality?
PET scans are rarely used for prostate cancer and even more expensive in the UK.
bone scans are useful to look for bone mets
after his hormone therapy stops, his testosterone levels will normally return.
this will cause a normal rise of his PSA back up which is normal.
if his testosterone returns and levels off and if his PSA continues to rise, then a bone scan should be done at that point to look for evidence of possible metastasis.