I am nearly two years out from RP, Gleason 9, negative margins and no evidence of spread. I am an otherwise healthy, active 68 year-old and feeling good. PSA has steadily ticked up from 0.009 after surgery to current 0.091. My surgeon, MO and RO at University of Pennsylvania all agree, given my trajectory and GS9 that early salvage RT with 6 months of ADT is appropriate at this point. My RO however suggested that since my PSA is still well below 0.2, I might consider waiting a bit to start RT/ADT to assess the pandemic situation this winter and avoid unnecessary risk of exposure to Covid-19. He said there is no rush at my PSA level, and data does not exist to suggest that starting ADT/Salvage RT would be any more successful by starting now or waiting until it gets closer to 0.2. I lean toward starting now and tend to trust the pandemic safety measures that U of Penn has in place.
Three questions for the group: 1) How much would you consider the Covid-19 risk in a decision to initiate RT now vs waiting; 2) Is anyone aware of any studies that show early salvage RT with ADT is any more effective by starting at PSA < 0.1 vs. 0.2? 3) My RO says no need additional scans for metastasis and that nothing would show up now anyway at my PSA level. However, my PSA at diagnosis was only 2.1, causing me to think my PC may not produce a lot of PSA. Does anyone have an opinion on whether to push for a scan prior to starting RT?