Yeah, given the heterogeneity of this cancer and the plethora of treatment choices, it can lead to paralysis by analysis.

Throughout my 11 year journey I have had treatment four times.

The first, surgery. It was a curative effort. Though successful, the MSKCC nomogram - https://www.mskcc.org/nomograms/prostate "said" I had a 30% chance of recurrence. Looking on the bright side, 70% chance of it not.

Next was SRT, we did the standard of care though I had advocated for more aggressive treatment, adding the PLNs and six months ADT.

When it failed, I was not surprised. It was a defining moment for me;

I realized I would never be cured

I would never again be the minority shareholder in making decision making.

I would be aggressive in my treatment decisions.

I would not regret my decisions but learn from them.

I changed my horizon for treatment outcomes from long term, say 10-15 years to 3-5 years, would this treatment work for that time, if so, new choices brought about by medical research would be in play.

I developed decision criteria to constitute what clinical data would trigger the next treatment decision. For example, three or more consecutive PSA increases spaced three months apart. This prevents reaction to singular data events.

This has reduced the stress between treatments, I don't have to worry every lab test, every consult...

I know going into each treatment decision that initially we have a defined period and clearly defined clinical response data for coming off treatment.

Eleven years in , three on treatment, eight off.

There is statistical data about the 5, 20 and 15 year survival rates which is "positive" news unless you are one of the ones who aren't, a friend of mine passed in less than a year from diagnosis.

While the data on survival may be "positive," the data on the side effects of treatment, well, we don't discuss that do we!?

It's ok to have a degree of anxiety, my labs are Wednesday. Do I have some anxiousness about the results, yes. That is mitigated by having criteria in place about clinical data sufficient to make a treatment decision, yes.

Last thoughts, statistics are population based and historical. This is a heterogeneous disease, not homogeneous so these statistics may not apply to you!

Kevin