@jeffmarc

Yes, I was less than pleased with the urologist who didn’t want to test my PSA for another year. Like I said, he did a 180 when he learned I had a pre-existing nodule, and immediately referred me to a urologist colleague who specializes in advanced prostate cancer, as well as ordering a PET scan.

The second urologist referred me to a radiation oncologist he worked with after seeing the PET scan results, as regards a treatment plan. That oncologist proposed 6 months of Orgovyx with IMRT. He cited the SPPORT trial in support of his recommendation. I had read enough literature at that point to question whether adding ADT to radiation would confer more benefit than risk (my PSA was still 0.11). Also, the SPPORT trial excluded any men with a palpable lesion, so it was unclear how that study applied to me, a point that the oncolgist conceded. I went for a second opinion with a medical oncologist. He was the one who wanted to start with a shot of Lupron, followed short-term Orgovyx along with a lutamide. Again, my PSA was 0.11. I thought his recommendation was way too aggressive. I was also aware at that point that many docs would not use hormone therapy for a relapse unless PSA hit 0.5. I ended up working with a different radiation oncologist who did not think hormone therapy was necessary. And at the point, I had decided that radiation was the only route I wanted to take.

My highest PSA indeed was 0.11 prior to radiation treatment. It first hit 0.11 in June 2025. Three months later, just before starting radiation, it was still 0.11 (and 0.097 on a Labcorp us test). I asked whether delaying treatment to get a doubling time was a sensible path, but both the urologist and RO felt that the PET scan results with the nodule showing intense activity warranted starting therapy sooner than later for better odds of success. I concurred with that assessment.

My next PSA test is on August 21 (9 months post RT). I will post an update on that once I have the test results.