So here is what the UCSF doctors decided. Trying to figure out how to feel.
PSA is now down to 0.3 from 51.3 in December
We had a long discussion Friday. Everyone said no brachytherapy. All the evidence we have point out that external beam is the way to go when a patient has disease in the bone. While we are not 100% certain but the radiologist thinks it is most likely cancer.
The metal in your pelvis and the prior radiation complicates the case but either way, the only thing that the guidelines endorse is the radiation to the prostate and the bone lesion. We will not be able to treat the nodes but again the guidelines do not suggest we should treat the nodes.
For 2 reasons:
1- He has disease in the bone. When patients have disease in the bone, we do not treat the bones. (I think he meant nodes as they plan to zap the suspicious spot)
2- He had prior radiation for his testicular cancer. Retreatment will cause a lot of toxicity. Initially we were hoping that we could treat only one side, but the new PET scan showed disease on both sides
There will be no spread of the cancer for a long time as long as the cancer is responding to hormone therapy. The evidence for this is that your PSA keeps dropping and is 0.3 from today.
After some time (in the order of years), the cancer "may" become hormone resistant at which time we will change the kind of hormone therapy.
Dr. Ghiam said that he will treat the bone lesion. (He will also do 20 EBRT to the prostate)
And I will continue to work with you and with Dr Ghiam.
I'm feeling quite blue to say the least.
Thank you all