Thanks for your participation and thoughtful input. It also reinforces my dilemma.

As I commented, I wanted a pre-radiation PSA. The oncologist wanted to start me on Lupron right away and delay the radiation for two months. I did not want the delay, but he said the Lupron somehow potentiates [my word] the cancer to make it more susceptible to the radiation. If that's true, that would be the right thing to do since that objective is to kill the disease.

This did not make sense to me, but I did not know how to push back. Doesn't Lupron slow prostate cell growth? Yet it was always my understanding that rapidly growing cancers are much more susceptible to cancer treatments that focus on growing cells. But if that logic is true however, it suggests that a bolus of testosterone who be a better pretreatment prior to radiation. Logic can lead you down the garden path? Lupron is doing the opposite; it slows growth we are told. Cognitive dissonance? Regardless, Lupron pretreatment will destroy a chance to establish a baseline metric post radiation. Maybe a baseline level of PSA is not that helpful in clinical decision-making?

Radical prostatectomy enjoys a beautiful and powerful tool in PSA, revealing what's going on at a biochemical level, and probably more sensitive than say PSMA PET. The push to do Lupron first drove my pre-radiation testosterone to zero, and my 6.9 PSA to 3, which 3 mo. post radiation/lupron, both were now undetectable. But, that's the effect of Lupron. The effect of radiation on PSA, my most sensitive tool, is now unknown. Unlike radical prostatectomy, I have little idea of what to do when my post radiation/post Lupron PSA becomes positive. As the Lupron fades (I'm 4.5 mo. post final* injection) I would like to have had a post-radiation PSA as a baseline, or some kind of guidelines.

There are likely some big flaws in my reasoning, so I suspect this will generate some needed push back, but I find it disappointing that oncologist who do this daily don't have information more readily available to assist patients in understanding or explaining these things. Even the PCF is not fully clear, or dare I say even clumsy, in mentioning post-radiation PSA monitoring. What I'm expecting is that in the next three to six months, PSA will reappear, and begin to climb. This may be totally normal, but it may signal serious problems on my door step. I have no idea. It is being measured to a reason. Are there clinical decision points: time of appearance; rate of rise, height of the rise? I'm assuming so, otherwise, why measure it?

OK. I'm done with my grumping.

*I elected to end it at 12 mo. The doc wanted 18 mo.