I read lots and lots about prostate cancer treatments but they are mostly for those with early detection. I am to the point there is not much left, and pretty much tired of seeing doctors.

I know most of the men with a very advanced condition probably don't feel much like using the internet. But I would very much like to hear about what I have to expect now that my PSA is skyrocketing. The last stage is chemotherapy but I am not so sure that is a good choice for me.

I have access to various counselors and such, but they require out-of-town trips that are getting logistically difficult for me. In addition, the doctors and such generally won't give me any straight answers and tend to hem and haw lots and in general are really vague. In addition, while I have access to very good doctors they are all overloaded and can't spend adequate time with me.

Once I had a different cancer doctor while mine was on vacation, and I mentioned how much time I probably had left and how much I could expect from chemotherapy, and he mumbled agreement, perhaps not realizing what he was confirming. Other than that, I have had trouble getting much detailed info. In the past I have had numbers based on what I read here and on web sites, and these tended to be more accurate than what I was told by doctors. For example, in asking my prostate cancer specialist, PhD and MD, involved in lots of research projects, what treatment was next, he said don't worry that it will be years before you need to worry about it. Six months later he told me he could do nothing further for me and I was gonna die...seek help elsewhere. It was most strange.

My wife is very concerned and stressed about how she is going to pay all the bills and handle final details. I really hate to burden family more than required. I would like to do as much as I can now while I am still capable, but this is a hard thing to find people with experience in since the experienced are mostly dead. I don't have enough resources to afford nor consult estate planners and such and since I have a negative estate it seems a moot point (I was uninsured, unemployed and too sick with side effects of treatment for years and had to spend everything before the state would pay for anything.)

A fair question, and one that I've thought a lot about myself. My father died of PCa in the 1970s, and the thought of suffering as he did does not appeal to me at all.

Right now, I'm in remission after SRT to deal with a recurrence in 2006, but I'm well aware that I'm one blood test away from moving into the big leagues. If I continue further down this road, I will make an appointment with the doctors at the local (well-respected) Hospice facility that I would likely use, and have them walk me through the expected progression and what they will be able to do to help me through it. I'll also try to meet with other patients (preferably those with PCa) and families currently at Hospice to see how their experience has been, and to better understand what is to come. BTW, Hospice services are paid for in full by most insurances, Medicare and Medicaid.

Over the years, I have had several friends and family members use the local Hospice facility, have visited many of them there and ALL have expressed complete satisfaction with the services they were provided, in terms of pain management, comfort, kindness, psychological and emotional support etc. Based on this track record, I expect that I'm going to be pretty satisfied with what is offerred; I think the Hospice groups have got their act together pretty well, and that things have changed substantially since my father's day (at that time, we had to argue with the doctor to prescribe any narcotic based painkiller even at the very end; his theory was that my dad might get addicted, and morphine would blur his mental acuity....which wasn't a bad thing IMHO).

But if I'm still not satisfied, I will take a hard, long look at moving to Oregon, which allows doctor assisted suicide for terminal patients in their final days (the Death with Dignity law). The experience in Oregon is interesting; the law requires you to apply for the lethal prescription some time in advance. But of those who get and fill the prescription, the numbers of those who actually use it are surprisingly small (only 46 in the entire state in 2006). I think that indicates that people get the prescription as a safeguard if their situation becomes intolerable, but very few actually find that they cannot cope, which may be a tribute to how far we have come in terms of caring for the terminally ill. I hope so anyway. Info about the Oregon law can be found at www.oregon.gov/DHS/ph/pas/ for those who are interested.