Not surprising. I think they should recommend adjuvant ADT at a PSA≥0.35 instead of ≥0.7 because I think patients are hoping for curative SRT and not just equivalent survival.
Also, they did not incorporate the results of the EMBARK and PRESTO trials that proved the benefits of adding Xtandi and Erleada, respectively, for a non-metastatic recurrence when the PSADT is rapid.
Whether PSA is detectable or not only depends upon the sensitivity of the particular PSA test. The arbitrary definition of biochemical recurrence hasn't changed (0.2).
Based on some previous research I saw earlier but can’t recall I thought that 3 PSA rises if PSA above 0.03 gave best result of cure. I think my ST which did not work was administered at 0.06 with my PSA post operation at 0.06 and then went down gradually to 0.03 but no lower. Trigger was pulled when three successive PSA rises of 0.01 took it back to 0.06. Had 6 months HT too. That was back in 2017.
Ironically I’m heading to a salvage discussion today. I will be asking , among other things, about ADT and combining a gen 1 and next gen to the treatment. As I read the new guidelines they only offer this on a trial. I’ll mention the embark trial and see where it goes.
Thanks. I had a great discussion with the doctors. They were the obvious experts in the room. Yet they took the time to go over my case and how it aligned with the recent salvage and BCR trials. They also are having a decipher test run. I’ll prob end up exactly SOC but they will let tests come back first.
ADT=androgen deprivation therapy = any of several medicines that prevent the testes from manufacturing testosterone (e.g., Lupron, Firmagon, Orgovyx, Eligard, Zoladex, or orchiectomy)
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