Eight years is a good run, but...

Just my thoughts as a layman who has traveled this path too.

It may be time to add a medical oncologist to your team.

It may also be time to throw the BS penalty flag on your urologist and find a new one. With your PSA, it seems inexcusable that he has not suggested imaging to locate where the recurrence is.

These scans, or the Aximun and C11 Choline scan can provide critical clinical data to inform any treatment decision such as where is the recurrence, prostate bed only, lymph nodes, how many, where, is there any bone or organ involved...any clinical data from imaging would be critical in a treatment decision.

Another piece of the clinical data may be your doubling and velocity times - https://www.mskcc.org/nomograms/prostate/psa_doubling_time

A general guideline is:

>12 months - monitor
6-12 months- consider treatment
< 6 months - treat.

There are other clinical factors involved, your age, life expectancy, health snd and morbidity factors along with your personal regarding quality versus quantity of life.

So, your Urologist handing you off as you described would constitute grounds for my firing him for failing to actively diagnose you using current NCCN guidelines - https://www.nccn.org/patients/guidelines/content/PDF/prostate-advanced-patient.pdf

Bring a medical oncologist on board.

Image - https://www.urologytimes.com/view/psma-pet-imaging-modalities-added-to-nccn-guidelines-for-prostate-cancer

Kevin

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