{"id":12981,"date":"2026-02-24T14:48:20","date_gmt":"2026-02-24T19:48:20","guid":{"rendered":"https:\/\/rickollie.com\/?p=12981"},"modified":"2026-02-24T14:48:45","modified_gmt":"2026-02-24T19:48:45","slug":"choosing-surgery-after-prostate-cancer-recurrence","status":"publish","type":"post","link":"https:\/\/rickollie.com\/es\/2026\/02\/24\/choosing-surgery-after-prostate-cancer-recurrence\/","title":{"rendered":"Hell to the No: Surgery over Hormone Therapy"},"content":{"rendered":"

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Y’all know last week I received my second 90-day Lupron injection for cancer suppression.<\/p>\n\n\n\n

\"Rick<\/a>
Not every step is easy. But every step forward counts. Cancer may change the path \u2014 it doesn\u2019t define the climb.<\/em><\/strong><\/figcaption><\/figure>\n\n\n\n

The treatment will never become familiar and no appointment is routine. Write that on your calendar and prepare for the side effects. Plus, you’ll learn patience as you wait for those labs to come in as well as anger management. I couldn’t tell you how many times I’ve refrained from telling people off since having this disease. <\/p>\n\n\n\n

Cancer changes everything. It has a way of reorganizing time. It doesn’t measure life in years. It measures it in injections, tests, scans and appointments. Along with whatever else your mind can conjure up.<\/p>\n\n\n\n

After radiation in late 2023, I truly believed that the nightmare had ended. For a while, it felt like it had. But about a year and a half later, when my PSA started creeping up again, I realized it hadn’t.<\/p>\n\n\n\n

A PET scan confirmed what the numbers were hinting at \u2014 active cancer cells. A follow-up biopsy of the confirmed it even more clearly: the cancer was back. Or never left.<\/p>\n\n\n\n

Tests and Scans<\/strong><\/p>\n\n\n\n

Confined it’s return in 2025.
<\/p>\n\n\n\n

Lupron<\/strong><\/p>\n\n\n\n

That\u2019s when Lupron entered my story.<\/p>\n\n\n\n

It wasn\u2019t part of the original plan. It became necessary after recurrence. And with it came a very human question I kept asking myself: What do the numbers actually mean?<\/p>\n\n\n\n

The PSA Drop: 9.19 to 0.08<\/strong><\/h2>\n\n\n\n

Before starting Lupron, my PSA had climbed to 9.19. Ninety-one days after my first injection, it dropped to 0.08.<\/p>\n\n\n\n

On paper, that looks good. In reality, it\u2019s a powerful biological response.<\/p>\n\n\n\n

Lupron doesn\u2019t kill cancer directly. It suppresses testosterone \u2014 the fuel prostate cancer feeds on. It starves it. So, when PSA drops that dramatically, it says something important: The cancer is hormone sensitive.<\/p>\n\n\n\n

A drop below 0.1 after three months is considered a strong response. It doesn\u2019t mean the cancer is gone. Lupron suppresses; it doesn\u2019t cure but it does mean the treatment is doing exactly what it\u2019s supposed to do.<\/p>\n\n\n\n

The Testosterone Reality<\/strong><\/h2>\n\n\n\n

I also had my testosterone checked for the first time when they did the PSA. It measured 0.48 ng\/mL \u2014 about 48 ng\/dL.<\/p>\n\n\n\n

For perspective, normal adult male testosterone typically ranges from 300 to 1,000 ng\/dL. Most men fall somewhere between 400 and 700.<\/p>\n\n\n\n

Treatment aims to bring testosterone into what\u2019s called ‘castrate level<\/em><\/strong>,’ traditionally defined as below 50 ng\/dL. Many oncologists now aim for under .20.<\/p>\n\n\n\n

At 48 ng\/dL, I reached the traditional suppression target.<\/p>\n\n\n\n

If my baseline was somewhere around 400\u2013600, that signifies roughly a 90% reduction in circulating testosterone in three months.<\/p>\n\n\n\n

Will the Numbers Keep Falling?<\/strong><\/h2>\n\n\n\n

Now that I\u2019ve had my second injection, the natural question is whether PSA and testosterone will drop even further. <\/p>\n\n\n\n

Maybe.<\/p>\n\n\n\n

PSA can move to a lower level as can my Testosterone. But the real goal isn\u2019t endlessly falling numbers. It\u2019s stability.<\/p>\n\n\n\n

Doctors look for sustained suppression like PSA staying very low and testosterone remaining in the castrate range. Small fluctuations don\u2019t matter. Trends do. Right now, the trend is in the right direction.<\/p>\n\n\n\n

Would They Treat the Prostate Again?<\/strong><\/h2>\n\n\n\n

My recurrence appears confined to the prostate. I responded strongly to hormone therapy. Thus, I technically fit the profile of someone who will be evaluated for salvage local therapy.<\/p>\n\n\n\n

Options can include:<\/p>\n\n\n\n

    \n
  • Salvage prostatectomy<\/strong> (surgery after radiation \u2014 complex, higher risk of incontinence and ED)<\/li>\n\n\n\n
  • Cryotherapy<\/strong> (freezing the prostate tissue)<\/li>\n\n\n\n
  • HIFU<\/strong> (heat-based focal therapy)<\/li>\n\n\n\n
  • Brachytherapy<\/strong> in select cases<\/li>\n<\/ul>\n\n\n\n

    Repeating full external radiation is uncommon because tissues have already reached tolerance limits. But oncology hasn’t ruled it out.<\/p>\n\n\n\n

    My urologist, who does the injections, brought up surgery almost instantly during my latest visit. Even before we had fully walked through the other options. It wasn\u2019t wrong. It was one possible path. But it felt fast.<\/p>\n\n\n\n

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