I am 58 y.o. and have recurrent PCa; 93 mos. post-RP my PSA is now 6 and I am probably about to start ADT. My uro suggests Lupron monotherapy until PSA goes undetectable and then off until some target level, and so on. Is this the current protocol of choice?


I think you missed several major opportunities to better control your disease. First, when you PSA started to increase, you had the chance to use radiation to put you back in remission. Second, there is now a wide range of options to slow the PSA doubling time and delay the need for hormonal therapy.

Now, with a PSA of 6 ng/ml and what appears to be a slow PSA doubling time, the first question you should be asking is where the cancer might be located. Much to my surprise, recent research strongly suggests your cancer may still be contained within the pelvis. It is likely to be in the prostate bed left after surgery or in the lymph nodes in the pelvis. This is especially true given the slow PSA doubling time you have had.

The first thing you should do is at least get a bone scan and CT scan to see if you can localize the cancer. A Prostascint scan is a better tool to find cancer in the pelvic lymph nodes, but it is far from perfect. If these tools find the cancer, the radiation therapist has a clear target to focus on.

If you do use hormonal therapy, it is important to recognize that your cancer has been slowly growing and treatment should recognize this fact. Because your cancer has been so nonaggressive, Lupron alone is very likely to put you into a complete remission. In fact, Casodex and Proscar/Avodart in combination would also likely to do that. In this process, the amount of cancer will be markedly reduced. This will likely be complete within 9-12 months. At that time, hormonal therapy can stop.

When you stop hormonal therapy, I think it is critical for you to consider trying to slow or stop your PSA progression. There are many options for this. If you do this, you are likely not to need to go back on hormonal therapy for many years.

Finally, the most aggressive approach to your disease would be to combine hormonal therapy with radiation to the prostate bed and pelvic lymph nodes.