My husband has suspicious recurrence in prostate as well as BCR mets in lymph nodes, etc.
He has been wanting to start ADT soon to treat BCR mets in lymph nodes but has to wait until after biopsy to confirm the suspicious uptake in prostate.
The questions are: is it ok to start ADT immediately after biopsy or does he have to wait until the prostate recovers/heals from biopsy? If he has to wait, when can he start ADT after biopsy (days/weeks/months)? Anybody has similar experience? Thanks very much.
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Without history and numbers it is so hard to recommend. However, as this is a go round for him, if metastatic lesions are suspected, start the Lipton/Eligard immediately and then discuss with a medical oncologist that specializes in genitourlogic cancers; particularly advanced disease of the prostrate. One item to discuss is micro-metastasis and how it will aff3ct him in the future. Is there a plan to tackle? Consider strongly systemic treatment with hormone treatment. Good luck and best wishes.
Thanks GD. Do you have recommendation for MO that specialises in genitourlogic cancers; particularly advanced disease of the prostrate that is knowledgeable to discuss micro-metastasis and how it will affect him in the future?
So far all MOs we met only talked about SOC treatment, ie ADT for micro-metastasis.
He CAN start ADT immediately. But that may not be the best strategy. If the biopsy results confirm recurrence in the prostate. Then he definitely should consult a radiation oncologist to prepare for salvage radiation treatment to the prostate plus the pelvic lymph node fields. Optimal timing for starting adjuvant ADT would be at the same time as the radiation. And it should be with Lupron or equivalent (not Firmagon) and not with bicalutamide. This is to take advantage of the androgen flare effect simultaneously with the SRT.
Here is a clinical study (below) on this confirming it is the better strategy. Print it and discuss with your doctors.
Thanks Paul for your advice. Alas it’s so difficult to pursue this best strategy. Scheduling is a MAJOR problem. These days every appointment takes weeks/months to schedule. So to time ADT flares with SBRT means delay starting ADT which itself is risky. Secondly most RO won’t do salvage radiation. Those few skilled ones who can potentially do again takes ages to schedule.So the only thing we can do is to start ADT soon buying us time to investigate options and make schedule work.
OK. I understand. It’s a difficult predicament. Most cancer centers have scheduling personnel that can coordinate timing of appointments in all departments once the primary intake consultation is done. Sorry it’s so difficult
Thanks for the link Mateo. I may be misreading it but it appears to only apply to locally advanced PCa and not to advanced (metastatic) PCa. Have I read that right?
Correct Benkaymel. It is not applicable to widespread metastatic that cannot be targeted by RT except for palliation. It could be deployed for SRT, local and regional and for oligo metastatic.
Agree. It is indeed most likely the combo with high T. Nat Lenzo in Perth advised me to stay on my high T phase through the entirety of my SBRT to oligomets and the Lu-J591 4-6 weeks after. I happily complied.
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Just Finished Radiation Therapy 
Timing of Radiation treatment after starting ADT
Radiation to lymph nodes after failure of SRT to prostate bed 
I am trying to decide if at the end of my ADT treatment in Dec 22 if I need to go on something else or just wait and see if PSA increases.
