Cancer still here

Sigh. New PSA test: no longer undetectable. My cancer is back or, more accurately, it never left. It would appear that the radiation treatment did not get the remaining cancer. When the effect of the hormone treatment wore off...my cancer showed itself again.

This is hard news.  There is still some hope for a cure but it is much less likely now.  I had never thought the probability of cure was high (maybe 50%?) because of my pathology but I was hoping for a lot more years.  Now the most likely future is years of hormone (ADT) treatment until it becomes ineffective and then fading away.

There are some hopeful paths: 

• Finding the remaining cancer and eliminating it. There are new imaging technologies that can find small amounts of cancer. My cancer amount is very small right now.  It might be too small to detect...but it will grow. If found it might be possible to radiate/excise the offending area. 
• New hormone treatments. As mentioned in an earlier post ADT is very effective at halting the cancer. Unfortunately in almost all men the cancer eventually finds a way with very minimal testosterone. At that point the cancer is referred to as "castrate resistant". There has been tremendous activity in the last few years to introduce new drugs to delay castrate resistance.
• Immunotherapy. There is great excitement, of course, in this area. So far the effectiveness in treating prostate cancer has been minimal. However, new stuff is coming out each year.

I have good teams on my side.  I am working with urologists and oncologists from Kaiser Permanente, UCSF, and Mayo to develop a strategy.

The news has put a new twist on my career.  Given my shortened lifespan do I want to continue to work?  Full time?  Part time?  Retire?  It is hard to think about stopping now.  I love my field and am at the top of my game.  On the other hand, a stressful job is not going to work now.  I want to enjoy the rest of my life.

More details...

• The team "castrate resistant" is used because historically there were no drugs to inhibit a man's testosterone production: the patient was actually castrated.  Glad those days are over :-)