salvage radiation and adt duration

[Elbers123]

Three weeks ago I completed whole pelvic salvage radiation. I was given a 6 month shot of leupron a month prior to the start of radiation. My dicipher is .76 My Gleason was 7a. My psa at start was .22 The leupron has been managable. My first blood test post radiation was <.04 I am 61yrs old. In two days I meet with a MO to discuss ADT duration. I assume some of my stats would lean to stopping ADT. I am not sure if my dicipher number would alter that thinking. Open to thoughts. Thanks.

[NanoMRI]

The question/challenge I felt I faced at the time of my salvage extended pelvic lymph node surgery was how much of the remaining cancer was confined to the treatment field; I felt this was the same question for salvage pelvic RT. Post my ePLND we set a hopeful PSA nadir benchmark of <0.010, without ADT. That benchmark would have been the same had I chosen salvage RT w/o ADT. As the benchmark nadir was realized I limited further treatment to one year only with bicalutamide and began bi-monthly testing and annual imaging, and since have added annual liquid blood biopsy testing. My intent is to no longer give this beast time and obscurity.

Have you established a PSA nadir target and follow on testing and imaging schedule with your MO? Hope this helps. All the best!

[Elbers123 in reply to NanoMRI]

Thanks,

[Mgtd]

We have almost identical diagnosis except I did not have a decipher test done. Not offered at diagnosis.

I had my pelvic area done as a precaution when I had the radiation. This was suggested by my RO and made sense to hopefully kill micro cancer cells.

After further discussions with my urologist, MO and RO, I elected to do 6 months of ADT. I reached a PSA nadir of <0.01 and my PSA has held steady at 0.05 for six months.

I am 14 months post radiation. My thought was to do as little ADT as possible and if needed by monitoring my PSA I would deal in the future with restarting ADT if necessary.

IMO it was the best decision for me. My QOL remains amazing and I can always continue the fight at a latter date.

[Elbers123 in reply to Mgtd]

This is my second go around. I think it’s my last chance for a cure so I’m trying to chuck the kitchen sink at it. But the insurance company may deny my enthusiasm. I did talk w my MO he seemed fine either continuing or letting drop.

Thanks for the input.

[ron_bucher]

With the caveat that no two cases are the same...my salvage radiation in 2008 without ADT gave me undetectable PSA for 7.5 years. Hope your MO has had hundreds of patients with prostate cancer. If not, I'd find one who has.

[Elbers123 in reply to ron_bucher]

Thanks, The MO is very experienced. But I wonder if there is a point of diminishing return. My original urologist was also very experienced but gave no weight to dicipher tests. It was a less experienced but equally educated RO who recommend test. But that ranking system is new and has not yet worked itself into everyday rank and file use. And I have zero chance of understanding its relative value. In the end I hope for results like yours.

Thanks for the help.

[ron_bucher in reply to Elbers123]

Adding opinions from more experts has made me more comfortable. In addition to the science, there is a lot of art in treating this disease.