4 Months ADT or 6 months.

[Tied2work]

My MO put me on 4 months ADT with 37 Radiation treatments for a recurrence. My RO suggested 6 months ADT with 37 radiation treatments. Confused.

[Tall_Allen]

Your RO is the expert at what works with radiation.

[VN6465 in reply to Tall_Allen]

Age 84. Diagnosed August 2019 Gl 9 w/no sign of spreading. Had high dose Brachy, 25 sessions IMRT and 18 months ADT with last infusion Nov 2020. PSA remains undetectable but T reading, which was 288 before treatment, remains basically undetectable at 2.5. Very concerned hearing that PSA readings may not be meaningful unless or until it hits 150 or more. My uro advised T may never come back at my age. Should I be looking into scans at this point? Always respect your opinion - any thoughts on this? Thanks.

[Tall_Allen in reply to VN6465]

Nothing to be concerned about. Nothing is growing, obviously.

[ron_bucher]

What was the RO's reasoning? My 2007-2008 post-RP radiation without ADT gave me 7.5 years of undetectable PSA.

For my 2nd recurrence, in 2016-2017 I had Lupron + Taxotere + radiation of more lymph nodes. The original plan was 18 months of Lupron. At 9 months I begged to stop, and my RO and MO agreed. My reasoning was 1) hated the side effects, 2) ADT is not curative, 3) I was anxious to find out what my PSA was going to do.

One of my MO's said my Testosterone needed to get to at least 150 or so for my undetectable PSA readings to be meaningful.

[Channelhomec in reply to ron_bucher]

Did you have a psma scan I am in my second reccurant situation 2 yrs> from radiation psa now 0.06

[ron_bucher in reply to Channelhomec]

I momentarily thought about PSMA scan, but didn’t want to give the cancer time to grow enough to become visible.

Since it was after RP and salvage radiation, I thought I needed systemic treatment like Taxotere. And the sooner administered the more effective it would be.

MO thought Taxotere would kill the “tiniest” tumors, and radiating more lymph nodes might kill “tumors too big for Taxotere to kill” (but too small to appear on a scan). PSA since then has been “undetectable” 5 years and counting.

[Channelhomec in reply to ron_bucher]

Thanks for the information happy new year glad to see you are doing so well

[ron_bucher in reply to Channelhomec]

You're more than welcome. Happy 2022 and good luck!

[Runner1957]

Had RP in Oct 2020 with recent reoccurrence. I started ADT 3 months ago which is planned for 12 to 18 months. Start 37 sessions of radiotherapy mid January. My psa last week was 0.01 down from 12 and rising before ADT. Wondering if ADT is not curative maybe this might be shorter??

[dadzone43]

When your only took is a hammer, everything looks like a nail

[Cooolone]

You had RP 15 years ago and now are recurrent with a slowly rising PSA... Not sure of any additional diagnosis...

The SPPORT trial had shown very good results for patients who've had RP and experience recurrence. The protocol uses RT with a short course of ADT for 6 months. It appears that this is what is being offered you. You can look it up and see all it's results.

What are you confused about? Not having ADT for a longer period? Again, diagnosis dependent... Many Oncologist like to use the least amount of treatment that may fit your staging and diagnosis, rather than over treat. A feather when a feather is appropriate rather than using a hammer when a feather will do!

Good Luck & Best Regards

[MateoBeach]

Finally getting the salvage RT to your prostate bed after BCR. Good. Should consider adding the entire pelvic lymph node fields if can be done with reasonable safety. Even if no nodes can be seen on scans yet. You should have had, or should get now, a PSMA PET scan. Your PSA is high enough to show you where the cancer is and rule out Mets outside the pelvis. Four or six months of ADT will help the RT work better at killing the cancer. Good luck. Insist upon the PET scan if need be.

[ron_bucher in reply to MateoBeach]

Sorry, but no scan is capable of ruling out tiny tumors in any region of the body. Metastasis happens before tumors are visible on any scan. PSMA may find “larger” tumors, but not all tumors.

[BMRboy]

I agree with Mateo. You definitely want to have a PSMA scan before you decide on your next course of treatment. The scan should be able to locate the site of your recurrence. Hopefully the combined SRT or SBRT and ADT, if appropriate, will be curative for you. Best of luck.

[ron_bucher in reply to BMRboy]

PSMA can locate only the largest sites of recurrence, not all sites.

[Horse12888]

As we've all seen here, oncs' recommendations on ADT duration vary. Not sure there is a right or wrong answer.

In my experience, 4 and 6 months are both entirely doable. Worst case: Even if you hate the SEs (like I did), by the time you're miserable, you'll see light at the end of the tunnel. The psychological effect of knowing that you'll start to feel good again soon is itself a powerful medicine.

[j-o-h-n]

Split the difference and make it 5 months.....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 01/31/2021 7:12 PM EST