I have the traditional Medicare and TRICARE For Life. The latter functions as Part D. A 90 day supply of Orgovyx has my co-pay at $68, so not an issue for me. I know for others with various insurance it is, both gaining approval and cost.

Side affects, the usual, hot flashes, mild fatigue, muscle and joint stiffness, genitalia shrinkage, some weight gain, about 8-9 pounds this go round. Bothersome, irksome, but not life altering. I still work which involves travel, most days I exercise, indoor bike, weights, swim. On weather cooperative days I ride my bike outdoors. For the last three years I have done the Garmin Unbound, a 50 mile gravel bike ride with my daughter or sister. Wife and I did two vacations this year, Iceland and Oregon. In January I went skiing in Colorado

It is an interesting decision point about when, with what and for how long when faced by clinical data such as a rising PSA only from an USPSA test. As with each of us, the decisions we make must be kept in context of our clinical history. My decision this time to wait until the PSA rose to .5-1.0 was based on my clinical history, surgery, SRT and triplet therapy. Were this a rising PSA after surgery in March 2014, I may very well not have waited and acted sooner, but...I would still have expanded the treatment zone to the PLNs, all of them, and added 6-18 months of ADT. In fact, at the time I chose SRT, I did act on two consecutive rising PSAs, .2 in September 2015 and .3 in December 2015 (there was no USPA at the time, or if there was, not mainstream clinical practice). Combined with my GS 8 and only 15 months to BCR, I knew SRT was the next step. There was no imaging at the time which would locate where the BCR was, my urologist and radiologist were welded to the SOC - SRT to the prostate bed. I had seen various data from CTs nd Mayo about the increasing evidence in guys like me, GS 8, short time to BCR, that PCa had spread to the PLNs and thus doublet therapy was warranted, extend the radiation treatment field gto the PLNs and include ADT for systemic therapy. I saw the data that said initiating SRT at lower PSA, some .3 or less, others .5, resulted in either "cures" or longer PFS. It makes sense.

Today we are faced with more or less the same dilemma for a rising PSA after surgery, treat at the first sign or, wait until PSA reaches a point that greatly improves the probability of imaging locating the recurrence, thus informing the treatment decision. The differences now and in December 2016, imaging, USPA, better software and hardware in radiology, ARIs....you get the idea, lots of differences!

So, a decision to do SRT as .05 is not "wrong." What may be "wrong" is not accounting for micro-metastatic disease and including systemic therapy and an expanded radiation treatment field other than just the prostate bed.

In my journey which is coming up on 10 years, my takeaway is to be proactive, have your specific clinical based criteria when deciding on when, with what and for how long.

In the four times I've treated, only wrong decision I've made is letting my urologist and radiologist talk me out of adding the PLNs and short term ADT to SRT. When we tested PSA 90 days after completing SRT and it had climbed to .7, they both apologized. The lesson learned was not wasted, never again would I passively let my medical team make the SOC my treatment and they became more active listeners to their patient.

I went to see the DIrector of Urology at a NCCN Center after that to discuss imaging with C11 Choline, then informed by that the use of triplet therapy, ADT, Docetaxel and radiation. He dismissed the idea, said he would out me on monotherapy, ADT for life...yep, I left, never went back, went to Mayo, had the C11 Choline scan done, did the triplet therapy and had 4-1/2 years off treatment. I have the same radiologist and brough a new oncologist on board, they both support my treatment decision this time, SBRT to the PLN identified in the Platify scan, 12 months of Orgovyx, then stop and monitor.

Kevin
Kevin