Leo Robot spares some nerves

It seems that normal practice is to reveal future appointments at the first RT session.

After making further enquiries I have now received a copy of my forthcoming 4 week timetable via email. I'm still not entirely sure which parts of my anatomy "the plan" will be targeting. Prostate bed, lymph nodes and where my missing lymph nodes used to be seem to be on the list.

However thus far there has been no mention of the mysterious "nonspecific uptake in the left pelvic sidewall" spotted by my most recent PSMA scan.

Jim

Yes, they gave me a list of appointments for the first week. At the first RT session the bloke at the desk said forget that list and then asked me if I prefer mornings or afternoons and drew up another list for that week. Each day they added the appointment for the same day the next week. They were fairly good at keeping to their times. I guess they have to try and keep the machines in use all the time, and as patients die, or new ones arrive the capacity changes at short notice.

I also called the Treliske oncology radiographers first thing this morning.

I now have an appointment for a face to face meeting with Dr. B in Truro, first thing on Thursday morning.

Jim

A result certainly! However it currently seems as though I'm unlikely to receive answers to my written questions before first thing on Thursday morning:

In advance of my meeting with Dr. B I would be most grateful if somebody could answer the question that I put to JD quite some time ago. "Can you direct me to any recent research papers and/or trial results addressing the pros and cons of HT and/or SRT for somebody in my peculiar position?"

PSA >130 pre op but <0.03 post op. PSA currently 0.35 but nothing "significant" visible on a recent PSMA scan.

I also have a supplementary question. Why was the repeat PSMA scan suggested by Dr. C on May 23rd 2021 and subsequently ordered by Dr. A cancelled when I referred the matter back to the oncology department?

Jim

Thanks again Jonathan:

The development of advanced imaging techniques such Ga-PSMA positron emission tomography/computed tomography, which are capable of localizing the recurrent lesion when prostate-specific antigen ≤ 0.5 ng/mL, has forced clinicians to reconsider whether patients should undergo radiotherapy without locate first the recurrence.

Slightly Spanish English, but I at least take the point.

Jim

I don't know how the confusion arose. Perhaps my prior discussions with Dr. A never made it into the notes?

She told me that once my PSA reading rose to 0.2 serious thought should be given to what action to take next given my preference not to "throw everything at the cancer". If and when it rose to 0.3, without any evidence of spread elsewhere, that action should be SRT to the prostate bed. For a long time I assumed that's what my "plan" must consist of even when informed to the contrary by others apart from my new consultant. I was sadly mistaken! However Dr. B agrees that is an entirely reasonable plan in all the circumstances.

Hopefully we're all now on the same page in this regard. With the possible exception of the mysterious "tiny focus of moderate uptake in the left pelvic side that does not readily correlate to any anatomical structure" on my most recent scan.

According to Dr. B if I wanted to avoid any short to medium term side effects one option would be not doing anything at all until my PSA reached  10-15. Starting (possibly intermittent) hormone therapy at that juncture would give me a life expectancy of 13 years "on average, but with a wide range".

I think I'll stick with Plan A, for the moment at least!

Jim

I'm currently in the midst of what is predicted to be a multi-day post Storm Eunice power cut.

Which indirectly reminded me to post my latest progress report. My online video call with my new consultant turned out to be with the oncology nurse instead. It was nice to see her face for the first time!

My PSA is down to 0.21, so back to watching and waiting for another 3 months.

Jim

1) No SRT as yet.

2) A bit of both I suppose. At our face to face meeting I pointed out to my new(ish) consultant that I was not of a mind to simply "throw everything at it".

That being the case, and with a significant PSA reduction, the most recent clinical decision seems self evident?

Jim