I had a follow-up appointment with the oncologist today with a PSA done 2 months after my 20 zaps of radiotherapy finished.
It has dropped from 0.4 (in both October 2016 and in Jan 2017, during which time I was on bicalutamide) to 0.1 on 13.4.17.
This turns out to be more uncertain / complex than I was thinking: she said the improvement might be the effect of the hormones, in which case, now that I have finished them, my next PSA might be up again, or it might be the radiotherapy working. Radiotherapy can bring the PSA down over 8-9 months, she said, so a lower PSA next time is likely if the radiotherapy is working.
This news is mixed and hard to digest: I had thought it would either be undetectable today, in which case the hormones-plus-radiotherapy had worked, or not undetectable, in which case it had not been successful and we would have been discussing options for further treatment.
I feel a bit silly for not having gathered how to judge the significance of the PSA level at this stage (and a bit irritated that they hadn't told me.)
Overall the effect is a reminder that the levels of certainty with all this are low.
Although it is positive that things are moving in the right direction, of course, I have often felt that it almost doesn't matter what the PSA is, in that there will still be another one in 3 months time. A small rise come July will not be taken that seriously and will result in the plan being a repeat PSA in 3 months, whereas an undetectable PSA in July will mean we can't tell whether there is still any cancer there or whether it will grow and the plan will be a repeat PSA in 3 months!
The only conclusion can be to do what I can to remain as fit overall as possible, continue to enjoy life as much as possible, and to carry on with the pelvic floor exercises. I continue to find the monthly Walnut group for gay men with PCa a great help.
I shall hope that the reduction represents the radiotherapy working, that it will continue to cause prostate tissue to be removed over the coming months and that my 3 monthly PSAs will be as low as possible. I will inevitably be anxious at each PSA test, so if these can become less frequent that would be good.
The prospect of being able to forget my cancer and consider it 'cured' is fading further into the distance. I wonder whether stopping wishing for that would reduce the disappointments, but it seems wrong to accept that: there is a pressure to fight.