Went with dad to see Mr P last night; his PSA is now 1.2 and the doubling time has increased from 4 years to 2 years to 21 months. According to Mr P, it will be about 10 years before the remaining cancer cells (which he is confident are in the prostate bed and have probably been there for the entire 19 years since RP) start to cause a problem. On that basis, we have agreed that there is no need to start HT until/unless the doubling time reaches 6 months - I asked about PSA thresholds of 5 / 10 / 20 but he felt very strongly that these are arbitrary numbers and it is the doubling time that should determine when to intervene. He also suggested that if/when Dad does go onto HT, he should go with intermittent approach which will knock it back in phases while allowing dad to stay as active as he currently is.
We talked about scans to confirm that the stray cells are actually in the prostate bed. He said that MRI is notoriously unreliable below PSA of 10 and although Dad could have a PET scan (choline or FACBC) he would have to pay privately - we agreed it was rather pointless since he won't have treatment yet even if the cluster is identified.
We discussed the fact that it is now 19 years since the op, and that dad was one of his first nerve-sparing patients; Mr P mentioned that his first nerve-sparing patients were 24 years ago and some are still here to tell the tale. Isn't that fab!
Finally, we had a chat about the PSA test and John's recent rise to over 0.1 and then back down again. He told us not to take it too seriously unless it becomes consistent - that at the cancer centre they have done some research on PSA which included testing women. The average PSA result for the women tested was 0.06 (and before Bollinge asks, it seems that these women are unlikely to have just had an orgasm). It seems this had played a part in the ending of the ultra-sensitive test.