“Is there a proven benefit to continuing ADT if you have high risk PCa even if your PSA is undetectable after RP and RT?”
I was diagnosed in November 2017 at age 68 after my PSA was found to be 45.5. Biopsy found Gleason 4+5=9, later confirmed by prostate pathology. Bone scan negative. CT scan showed one likely pelvic lymph node. Two Axumin scans (one just before surgery) also showed just the one lymph node.
Had RP in February 2018. Margins negative but PCa was extracapsular with seminal vesicle invasion. Of 69 lymph nodes dissected only the one was positive.
In June I started 30-days of bicalutamide followed by a 6-month shot of ADT (Trelstar). I underwent 37 sessions of IMRT beginning in July.
My post-RP PSA was .01. My post-IMRT PSA is undetectable as of two months ago—I’m scheduled for another test in January.
All this seems like very good news, but I don’t want to let down my guard. My question is should I continue ADT anyway? For me the side effects have been relatively tolerable, mainly hot flashes largely controlled by Estradiol patches Of course, the ED and lack of libido is depressing, but I have many other joys in my life and am in otherwise excellent health, very fit and active
Based on what I’ve read, I believe that continuing ADT now will not improve my survival odds. I’m hoping that one of the smart folks on this forum can confirm that belief with clinical evidence.
Thank you, and Merry Christmas!
I’m not as smart as some of the experts but I can at least identify with your situation as you can see from my profile.
My observations based on experience:
Gleason 9 is virtually incurable particularly as you’ve had SVI and ECE as did I which necessitated SRT.
ADT is holding your PSA down and will continue to for a while, likely a few years. If you stop ADT, PSA will climb again.
Since mets were found in a lymph node there likely are micromets elsewhere in your pelvic lymph nodes which is where mets are typically found first once they escape the prostate. That’s what happened with me. So I had all my pelvic lymph nodes hit with 75 grays of IMRT.
I’ve had no recurrence in prostate bed or lymph nodes.
I did stop ADT three times and each time I had recurrence in bones. Then I had axumin or PSMA scans to find the mets which I hit with sbrt.
So that’s my experience. Take it for what it’s worth.
Thanks Bob—it does seem that your experience is quite similar to mine except that my RT was ajduntive as opposed to salvage. I primarily base my belief on Dr. Patrick Walsh’s book. He says (in the the current edition, published this year) that he believes “if there is no cancer in your bones and no sign that anything is wrong other than a rising PSA after surgery or radiation...in most cases there is no evidence that starting hormonal therapy immediately as opposed to later will prolong life.”
I know that new studies and treatment options for PCa are rapidly emerging, so I want to see if anyone here can point me to new information on this topic that wasn’t available when the above was written.
I will naturally consult my MO about this, but I have found that being forarmed with good current information makes those conversations more productive.
Tall Allen is the expert here. Everything he says is backed up by clinical trials .