Hello. I have heard of you via the various cancer survivor boards. I have consulted online with Dr Strum. I am gathering as much information from learned doctors as I can. My husband had radical prostectomy on 7/14. Gleason 4+3, 2mm focal + margin. Some debate about extraprostatic extension. Husband had taken Propecia for years, but no one accounted for this by doubling his PSA score. Accordingly, had them do an unltrasensitive test, rather than regular PSA. Fortunately, this returned less than 0001. Dr Strum and surgeon in Detroit recommend monitoring PSA. Dr Strum says with ultrasensitive assay not much ground would be lost in the event of a recurrance. Oncologist in Columbus Ohio is strongly pushing adjuvant radiation. My husbands diet is good; we’ve eliminated red meat, processed foods, etc. He is 59. He is taking POM pomegranite capsules, 5mg citrus pectin,cayenne/tumeric blend and vit
amin D daily. We are stuck/stymied re the radiation question for a variety of reasons, largely quality of life related. Given his situation, do you have an opinion about course of action? Thank you Claire


I am missing one key number: what was his PSA at diagnosis? In any case, if he did have extraprostatic extension, then he has pT3a prostate cancer, which would make him high-risk for recurrence. The presence of positive margins also put him at an elevated risk for recurrence. In this setting, I would usually recommend adjuvant radiation therapy. One major issue is whether to radiate just the prostate bed or to extend the radiation to the lymph nodes most likely to be involved. This is a very controversial area and the clinical trials are far from definitive. However, I am very impressed with the frequency with which these lymph nodes are involved when patients present to my clinic with relapsed disease. Additionally, in skilled hands, these lymph nodes can be irradiated with minimal risk. So, I usually favor radiating both the prostate bed and the lymph nodes. But you need to know that I am probably in a minority in this.

Finally, I disagree with Dr. Strum’s adjustment of PSA doubling time. . It is true that Propecia, Proscar and Avodart will reduce the PSA in men with their prostates intact and that this reduction will average 50%. However, in an individual case, the reduction can range from nothing to as much as 75-80%. For this reason, automatically doubling the PSA is probably not valid. Furthermore, while these drugs reduce the PSA, they do not alter the PSA doubling time artificially. This should be obvious from considering what is going on. These drugs reduce the amount of PSA produced per tumor cell. Even on these drugs, if the PSA doubles, the amount of cancer is also double. There is just less PSA from each tumor cell. So, while the PSA starts from a new baseline, the PSA doubling time and its meaning are unchanged. If the PSA doubling time is reduced, it is because the actual growth of the cancer has been slowed.