Dear Knowledgable Member,
Under what circumstances, is using intermittent ADT the only necessary treatment ?
AND
What would be standard treatment where PSA steadily rises from 0.01 to 0.09 in 22 months after an RP. Doubling every 11 months. G3 +G4 with no other involvement except for a singular focal margin.
Thanks folks
It doesn't make sense to measure doubling times with PSAs less than .1. If your PSA continues to rise above .2, then you might want to discuss getting salvage radiation with a Radiation Oncologist. The addition of ADT at that point could be considered.
Right now you don't need any treatment, just keep watching the PSA.
My Oncologist and Urologist said they would consider treatment at .09. I had a positive margin. 0.1 it seems is becoming the threshold with my doctors.
Of course it's completely up to you and your doctors to decide what you are going to do. Just passing on information.
Here are some guidelines about salvage radiation from the American Urological Association.
They define Biochemical recurrence as:
Biochemical recurrence after surgery is defined as a detectable PSA level > 0.2 ng/mL with a second confirmatory level > 0.2 ng/mL.
auanet.org/guidelines/prost...
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A recent randomized trial found that a good time to begin salvage radiation (SRT) is after there have been three consecutive PSA increases or when PSA reaches 0.1 - whichever comes first.
prostatecancer.news/2019/09...
ADT is unnecessary as long as SRT begins before PSA reaches 0.6.
intermittent ADT is inappropriate when there is every reason to believe a cure is possible.
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Quit worrying yourself to death. You are undetectable at <0.1. I never considered intermittent ADT. When cure is possible do everything you can to kill the little bastards.
Seriously, if you want your PSA to rise, stop the Lupron injections. I stopped after 7 years. Reason, to see if my treatment worked and a belief by my MO that I was cured.
Me? I was a Gleason 7(4+3). I also had two Mets to my spine.
GD
Just read you profile. You talk about type a and b personalities. Have you read Lydia Temoshok "THE TYPE C CONNECTION "? It might give you some insight into yourself.
I haven't. What is the C connection?
The Cancer Connection. It has to do with cancer and personality.
I couldn't find the book? Still in print?
Yes as above. You have the possibility of cure. It is that one positive margin that is your indicator of the most probable location of remaining cancer. So salvage radiation to the prostate bed is what is called for ( and supported by research). And strong consideration to including treatment of the pelvic node fields at the same time. Go see the best radiation oncology center and doc that you have access too. It is a window of opportunity.
You've been through it!
Next Treatment Step
Hormone treatment 
SABR treatment options
Systemic treatment
fasting before radiation treatment
