You haven't given us enough information (nor does your bio) to even begin to think about this. You stated "Recent PSMA scan negative no recurrent disease ." and then asked about radiation. Exactly what are they going to radiate?
It's been 10 years - and you're still below 2.0PSA.. (0.4?) - I again have to ask - what are they going to radiate?
If your original treatment was a RP - then the 0.4 might be some cause for concern - which at this point would probably be watching and waiting to see if it continues up, or if it was just a blip. Personally I certainly wouldn't make any sort of decision based on 1 PSA reading (and not a particularly high one even if you did RP, and insignificant if your treatment was originally radiation.) And I'd certainly want another PSA test (even if out of pocket - it's not expensive) along with a T test before even thinking about doing anything.
Photon vs Proton - no particular advantage to photon except the selling points the treatment centers like to trot out when you drop by (BTDT). Have you had any radiologist not associated with a proton center advise getting proton?
I think you're perhaps over-reacting to a number on a chart.
Thanks for your feedback I do appreciate it and really apologize if I did not give you enough info.
I asked the same question to the oncologist. He indicated the prostate bed would be radiated. I had surgery in 2003 and the PSA was zero until 2013 in which it bounced going no higher than .03. Then two recent consecutive tests 0.48 then dropped to 0.42. My urologist indicated the watch and wait approach but suggested if I wanted to see a Radiologist which I did. Again, sorry all for not giving you all the info.
Salvage radiation is not bad, maybe some fatigue. ADT is tougher. I've been on it for close to 20 months now. Many side effects. My 2 cents is that with biochemical recurrence after that amount of time radiation should include prostate bed and pelvic lymph nodes. My father in law had recurrence after 10 yrs, that was ~ 10 yrs ago, no PSMA PET available for him back then, the standard of care was radiate prostate bed only to later find out he had it in a pelvic lymph node. Now it has metastasized throughout his body. Good luck.
I hope there is some truth to proton tx being less destructive than photon as I just recently completed SBRT with proton…..space oar placed as well…….no SE’s yet.
Quite a few SE,s with lupron but none that would require stopping it…major fatigue,harder to concentrate,muscle wasting,loss of all body hair…..22 lb weight gain immediately, elevation in glucose but not to diabetic proportions yet……**luckily no hot flashes. Pain in the butt overall but effective so far(psa undetectable)…….wont know if the proton therapy was effective for quite a while……good luck to you.
If it were me, I would just watch it. But you're not me, so you have to do what's right for you. My thinking is that if a bit of pattern 3 got left in the prostate bed, pattern 3 progresses very slowly, if ever (it can grow and form a tumor, but it seldom changes grade), and most (but not all) men on active surveillance with pattern 3 only, have stayed on it without grade progression for 20 years so far.
With watching, there are no side effects of radiation, but there is the anxiety of knowing something is still there.
Each guy's body reacts differently to the same treatment(s). For me, Lupron was a lot worse than either of my two radiation treatments. Lupron turned me into a couch potato even though I've always exercised regularly to keep in good shape, whereas with radiation alone I could do cardio exercise regularly for 90-120 minutes at a time. Radiation weakened my anal sphincter/rectum slightly but it doesn't require anything other than hitting the restroom a little sooner than I used to when the urge hits.
My first radiation was post-RP salvage radiation done without any ADT and it gave me 7.5 years of undetectable PSA.
Your age is a factor. For example at 80 what I might do may not be what someone at 60 might do. In addition what is your current health? That plays into the decision. Not a simple decision. Good luck!
Thanks I am 73. I ride my bicycle approx. 150 miles per week spring and summer. Train on the bike in the winter 5 days a week and lift weights 5 days a week. Thanks again
Given what you describe for a clinical history, seems low risk...
There are choices...
Continue to actively monitor with labs and consults, what distance apart, if you are concerned about progression, maybe every three to six months, discuss with your medical team.
Do something...when, with what, for how long...?
Treat the prostate bed only.
Include the WPLN is the radiation treatment.
Add short term ADT, say six months. Then the question is which ADT, agent, do you add an ARI...
Simply do doublet therapy, ADT +ARI, no radiation...
I would discuss with your medical team about what PSA they would consider imaging at. We know generally that the higher one's PSA, statistically the greater the chances of a PSMA PET locating the recurrence and informing that decision. Where is the sweet spot, some say .5-1.0, others are willing to image below that, some wait for an even higher PSA. The question you may want to discuss with your medical team is will imaging inform a treatment decision. As an example, if your medical team's current approach and yours) is to radiate the prostate bad only, imaging could alter the treatment plan if it showed recurrence outside the prostate bed. You can also discuss with your medical team any risks they see with waiting for the PSA to rise before imaging.
As others have indicated in their response, I would continue to actively monitor, labs and consults every three to six months, image at some point in the future, accumulate more clinical history - PSADT and PSAV, maybe genetic testing, and then decide. In the meantime, I would enjoy life off treatment.
Thanks for all the information!!! You are very kind. I am trying to digest all of this and its confusing. I suppose I am lucky in the sense that I am a grade 1 gleason 6, I suppose.
Hey cutest know that radiation is like a slow burn and has its own side effects unfortunately none of them are good. Like chemo it basically kills Celsius and is indiscriminate the most is hopefully your good cells regenerate faster than the mutated cells, and if they get it all there no guarantee the bad cells won't come back so 50 50. Ad will arrest your cache cells effectively making them Dornant which worked for me, but everyone is different so again I say 90 10 for many years, maybe forever. Lupton with nilutimide works well with some uncomfortable dude effects, sweating hot flash some nausea but u get used to it or I'll say it's tolerable. Chemo and radiation by fast have the worst affects, hair loss, low energy, nausea, reflux skin lesions, depression anxiety and a host of others but many people freak with it with a level of difficulty in sure, so it's your preference really, you may not get this affects and maybe they are not so bad for you. For me it comes down to your drive, your spirit positive affirmation and especially your outside influences, people have diffrent energies and we are subject to them which can and will impact how you feel and think about yourself so that said, surround your self with positive people that are doing positive things, you don't need the pity or empathy pot that's a tough road to travel my friend. Hope this helps and stay positive, you already beat this and are winning, you have to walk in it like you own success. Love n light friend.
Agree there appears to be no reason to act now, but if/when you do, know that side effects from Lupron are nearly always much more noticeable and varied than those from radiation. Modern radiation is well tolerated by most. I’ve had no lasting effects for 5 years.
Again, Lupron is the main driver of side effects. However, shorter courses are fairly easy -beyond 6 months or so it becomes gradually more challenging.
Lots of exercise, especially weight training is your best intervention on the sides. It’s vital when getting older as it is, but Lupron slows metabolism, adds fat gain and wastes muscles. This makes for fatigue that can overtake your will to exercise and compound the effects. Do not ignore this simple but important matter!
Thanks. I ride my bike in the spring and summer 150 miles per week and train in the winter plus lift 4 days a week. I cringe when I think of the effects...but if I can nail this.. I thought of only Radiation.
My only comment regarding radiation doesn’t directly apply to you but may be helpful. They found a lesion on my L4 and was receiving Lupron. Had SBRT with zero side effects. Salvage or broad based radiation would likely be different and even SBRT would vary depending on location. As Tall Allen said, if it is low grade and not a bright PSMA indication, patience may be a virtue.
I just finished radiation in January after 6.5 years on Lupron (still on it). Main thing from the combo was another level of energy drop over and above the Lupron--noticeable but manageable.
Radiation does have its own set of side effects, like urinary and digestive issues, skin issues, etc.
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Back on lupron inspite of the terrible side effects 
Lupron and cataracts.
PSA rise during/after consolidation radiation 
Radiation side effects
