ASTRO and AUA Guideline on Radiotherapy After Prostatectomy Guideline Statement 9

[Muchacho]

HI,

I am new to this forum.

A bit of background, my dad passed away from PC at age 70 in 1988. In 2008, when I was 50. I was diagnosed with PC with a pre op PSA of 3.17. I had a robotic prostatectomy in May of 2008. I remained free from biochemical recurrence until January of this year, when my PSA was .2. I underwent salvage radiation with 39 treatments for a total of 70.2 gray to the prostate bed.

Recently I discovered the release in the title above and presented it to my RO, which was after completion of salvage radiation. The statement 9 referred to above recommends with level 1 evidence that salvage radiation candidates should be offered ADT. My RO felt it was not too late to add the ADT and asked that I speak with my urologist. The urologist started me immediately on Casodex and a week later, a one month shot of Lupron.

I tolerated the salvage radiation well with only minor fatigue, but the Lupron is making me tired.

Anyone have thoughts or advice?

[Tall_Allen]

Adjuvant ADT only had a demonstrated benefit when PSA > 0.7 (RTOG 9601) or when there were significant risk factors:

pcnrv.blogspot.com/2016/08/...

pcnrv.blogspot.com/2018/01/...

It's not at all clear that there is any benefit when SRT begins at a low PSA, when there aren't significant risk factors, or when a high enough salvage radiation dose is used.

It should be your decision.A man in my support group is taking it in spite of the probable lack of benefit for him because he feels safer doing so and doesn't mind coping with the side effects for 6 months.

[Muchacho in reply to Tall_Allen]

Thanks. I did not see the .7 psa cutoff in the new statement #9, healio.com/hematology-oncol....

[Tall_Allen in reply to Muchacho]

You have to read a little deeper in their guidelines to see it. Further on, the AUA guidelines state:

In RTOG 9601: "Survival was improved with bicalutamide in most reported subgroups, and was statistically significantly so in those with Gleason score 7, trial entry PSA 0.7-4.0 ng/mL, or positive surgical margins."

They also state: "More high quality evidence will be required to identify subgroups that would and would not benefit from the addition of hormone therapy to SRT, and to provide specific recommendations on the type and optimal duration of such."

auanet.org/guidelines/prost...

So you have to look at which subgroup you fall into, and make a decision based on available evidence.

[Muchacho in reply to Tall_Allen]

You are doing all of us a service by following this so closely. My urologist is to see me after 1 month of the ADT. I am going to discuss this with him.

[JavaMan]

I am on Lupron now as well and going through radiation currently. Tiredness is a known side effect. Exercise a lot to beat it. It really helps keep your energy level up.

[Muchacho in reply to JavaMan]

Thanks, exercise is helping me. It has only been a week since my first Lupron, but I do feel the effect.