been watching my Prostate cancer since 2010. Performed local focal ablation 3 times with no success. 2022 had divinci robic surgery, after 1 year PSA 0.8. They are recommending radiation MRI guided. (View Ray)Our US Prostate leader is recommending Avodart to keep the PSA down for as long as possible then Casodex until something better comes available. What are your thoughts on avoiding radiation. I have no problem watching PSA just don’t won’t it to metastasized.
Thanks Mark
Check what I have elected to do in my "Bicalutamide Maneuvers" thread. I also take Avodart but started Bicalutamide at a lower PSA of 0.17. I think that before deciding a PSMA PET/CT is in order.
PSMA clear
MRI clear
Why are you "avoiding radiation"? If it had been done right in the first place, you could have avoided a lot of unnecessary procedures.
Using substandard ADT is the same sort of short-term, faulty logic.
where do you shoot the beam. PSMA cannot detect cancer so they are shooting in the dark or a good logical place like the prosthetic bed. Might be somewhere else
And with a PSA of 0.8 the probability of it being out or in+out of the target area, is (off the top of my head as I know of 4 relevent papers from the USA and Europe) roughly 50%.
The "natural history" of prostate cancer is well characterized after over a hundred years of clinical observation.
Prostate cancer always spreads from the prostate to the prostate bed. You are overestimating the ability of a PET scan to find cancer - it only has 40% sensitivity. Tumors that are smaller than 5 mm (and most are smaller than that) do not show up at all.
The SPPORTS trial proved the value of irradiating the pelvic lymph nodes if PSA>0.35. Recent improvement in clinical observation has expanded the treatment area, while technological development has lowered toxicity.
they also want to give me lupron
Just be certain you’re dealing with a VERY experienced RO! Ten years after SRT after failed RP, I’m totally incontinent due to scarring in urethra . Wearing Foley catheter after failed AUS and sepsis, first in scrotum and a month later in right kidney. Spent three weeks in hospital the first time and one week the second plus a week at home getting IV antibiotic infusions .
What sort of ablation?
focal laser ablation, laser my one 3+4 tumor, left apex
I received High Intensity Focused Ultrasound (HIFU) ablation. My urologist/surgeon recommended full gland, not focal, ablation and I was a good candidate for it given that I had had TURP surgery 10 years prior for BPH (enlarged prostate). I had excellent results. Almost 7 years later my PSA remains under 2 and I've been off ADT for more than six years. I was only on it for six months and was given that injection on the path to radiation ... before I changed my mind and went with HIFU instead. So yeah I wasn't a fan of radiation either but that might be a option you should consider at this point.
I'm not very clear about your situation but I wanted to point out to you something. I looked up Avodart side effects and it lists "high-grade prostate cancer" which seems to say that it causes PC. (Great! A med for BPE that causes cancer! Just what you need...not.) I guess you are saying that you have had benign prostate enlargement until 2022 and then you had a prostatectomy and now you have PSA 0.8. That is an indication of possible prostate tissue in the body, maybe pc. So I suppose you already have PC? The doc's seem to be saying that they want to locate it and zap it IF it shows on an MRI. I presume that they would only zap it if it is cancerous. But first things first. You need to see it and know what it is before radiation therapy. That would mean an MRI guided biopsy prior to treatment.
I’m aware that Avodart can cause higher Gleason scores. I’m afraid radiation will not work then have to do ADT
It does NOT "cause" higher Gleason scores. After long time use, it lowers the PSA reading down to half the untreated value. So, when patients and their uneducated docs get things moving after a 5 or 6 (up to 4 is considered "normal") it is in reality a 10 or 12, i.e. high risk.
The hole you dig is getting deeper
January of 2018 my PSA shot up from 8 to 54 in a month, did the biopsy, they found 10 shots 100% positive, but only in the prostate area… I opted for the Brachytherapy high dose internal radiation… after the HDR treatment I had 8 weeks of external radiation, along with Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy. because prostate cancer lives on testosterone… this is administered every 6 months… a foot note, if you are a man who loves sex, this hormone therapy will shut your little boy down completely…
So after 2 years of no sex, or absolutely no feeling for sex, my oncologist takes me off the drug…
Fast forward… last March (thank God) my oncologist told me not to die from something else because my PSA after my HDR treatment was and still remains at 0.078%
I would recommend this treatment… look it up.. it is very popular in Europe and Canada…
Best of luck my friend…
God Bless
To Radiate (the Prostate) or Not to Radiate (the Prostate): That is the Question.
hormone therapy and Salvage radiation with PSA at 2.41 
Treatment options for local PC that is resistant to radiation 
Radiate just the prostate when there is extensive lymph node involvement?
PSA post salvage radiation
