At the age of 70 my most recent treatment was a Robotic Prostatectomy after which pathology report was Gl 3+4 prostate cancer, pT3a (EPE and bladder neck invasion), N1 (1/15 nodes positive), multiple positive margins.( Prior to that I underwent Cryotherapy for prostate cancer in Mar 2012.)
My PSA level never dropped to undetectable after the prostatectomy. Initial PSA after robotic surgery was 1.25 ( Nov 2022)
Further tests showed mostly steady PSA increases :
Mar 2023 -PSA 1.73 Jun 2023 -PSA 1.95 Sep2023 -PSA 1.70 Nov2023- PSA 2.5
I had 2 subsequent PSMA PEST scans:
DEC 2022 GA68 PSMA PET scan indicated no definite evidence of recurrent or metastatic prostate cancer.
Nov 2023 Plarify PSMA PET scan indicated no definite evidence of recurrent or metastatic prostate cancer.
My urologist/surgeon recommended intensified ADT (LUPRON + ENZY) after the initial PSA of 1.25. I have since declined up to now.
I have consulted 3 radiation oncologists in the last two weeks, all whom recommend salvage radiation (35 IMRT treatments) to the prostate bed and to the pelvic lymph nodes along with 6 months of ADT (Lupron).
Their collective theory is that microscopic disease is prevalent in the prostate bed with one concluding that my cancer is PSMA negative resulting in the negative pet scans.
From what I understand the radiation will be more of a means of keeping future PSA levels at undetectable rather than providing a cure which would most likely require additional ADT.
I am wondering is it worth risking the GI and GU side effects related to radiation or would the intensified ADT be the better option? Has anyone else experienced this situation?
Thanks so much for this wonderful forum
Guy