What's the usual next step after finishing RT while continuing ADT plus Z&P?

[Joes-dad]

What's the usual next step after finishing RT while continuing ADT plus Z&P?

I'm stage 4, GS8 with enlarged LN's in my pelvic region.

- I've been doing ADT since January (Firmagon then switched to Elligard)

- Zytiga & Prednisone since February

- Finished 9 weeks of IGRT, 2 week's ago

- PSA went down from 86 to 1.05 when IGRT started

I have my next 3-month Elligard injection this week followed by an appointment with my MO to review the bloodwork they'll do then and to "chat". In a few weeks I also have a follow-up with my RO.

What is the normal next steps? I'll be continuing the ADT plus the Z&P. Do I just watch for a rise in PSA for now? Are there other things I should be doing?

[Tall_Allen]

Yes, after the ADT wears off, you may see a small rise in PSA before it reaches a nadir.

[Joes-dad in reply to Tall_Allen]

Due to my LN's being enlarged, the current plan was to stay on ADT forever (plus the Z&P unless it stops working). I'm wondering if I should be doing anything else now or just keep watching my PSA to see if it continuously go up somewhere down the road?

[Tall_Allen in reply to Joes-dad]

Didn't they treat the pelvic LNs with radiation? Were there other cancerous LN's outside of the treatment field?

[Joes-dad in reply to Tall_Allen]

Yes, they did treat the Pelvic LNs during the IGRT. That was the only sign of Mets seen in the scans (CT & bone scans). Do you think they are being overly cautious by recommending I stay on ADT, etc?

[Tall_Allen in reply to Joes-dad]

You may be cured. The only way to know is to come off ADT and see what happens.

[DeanNelson in reply to Tall_Allen]

Praying for cured

[larry_dammit]

Wait and see. It’s a waiting game if they caught it early enough. My dad is in the same situation. Will meet with the urologist today to see what he says then I’ll take him to see my oncologist.

[Rmanns]

The usual next step is to continue Zytiga and prednisone until the cancer morphs around it, hopefully several years from now. I got 2 really good years from Zytiga. Watch, with your medical oncologist for a rise in PSA, watch for the time it takes for your PSA to double. Some docs want your PSA to hit 10 before they move on others are more aggressive. Talk to your doc now about those decision points.

Normally after PSA comes back (if it does) after Zytiga chemo docetaxel is next. I tried Xtandi after Zytiga with little effect then RAD223 after Xtandi, with poor results. Now taking Jevtana to slow the progression down.

You still have lots of options.

[cancervictim]

My husband is also on long term ADT + Z +P (post RP- pT3b and sRT). He is thought to likely have micromets although nothing was seen on conventional scans. He's coming up to a year on this regime. We are afraid to stop the drugs and let the G9 beast out of it's cage. (PSA undetectable now), Like you, there's a chance that he's been cured. If that's the case, PSA wouldn't rise after years of these drugs and that's how we'd know he'd been cured. . Maybe that's the safest path.