2 months Firmagon...then 30 days Salvage Radiation?

[JPnSD]

I am 14 months post-RP (GL 9 , T2N1, Stage 4, DECIPHER .78) and my PSA has gradually risen from .01 to .13 as of the last test in Sept. At this point...the consensus (URO, RO and MO) is to do 2 months of Firmagon/Degarelix ADT (starts Monday)....and THEN do 30 days of SRT...and continue ADT for 2-3 years. They say that 2 months ADT is needed to "sensitize" the cancer cells. I can't find documentation that states this or explains how it happens. Can anyone recommend some documentation? I also wonder if 2 months is prudent to wait for starting SRT? Thanks and wishing all a safe journey.

[Tall_Allen]

Yes, that is well known that ADT radiosensitizes cancer cells, and it is always administered neoadjuvantly. It weakens them, preventing any growth in the interim. It is quite safe - in fact, it will prevent any progression. 2 months seems adequate, but undetectable PSA and castrate levels of testosterone insure that enough neoadjuvant treatment has occurred to begin radiation. Here are a few references from my files about the theoretical mechanisms:

stm.sciencemag.org/content/...

redjournal.org/article/S036...

clincancerres.aacrjournals....

openarchive.ki.se/xmlui/han...

[jjpeabody]

Thanks for your post. The docs should have specific references. What is your age and PSA doubling time. 2 months sounds ok and you will start SRT at about 0.2. Also do you currently have incontinence and did docs have any comments about that. Good luck.

[JPnSD in reply to jjpeabody]

A robust 67. Thanks for your reply.

[DJBUNK]

You and I are in a very similar situation. I am 13 months post-RP (G9, T3bN1). PSA at 6mths was 0.03 so my RO recommended 30 day Cassodex, followed by Lupron. Two months into ADT, I began 36 sessions of radiation which ended almost 2 mths ago. Before beginning this second treatment, I sought 2nd opinions from Cleveland Clinic and JHU. Both agreed with this plan. As with your doctor, my RO wanted to begin ADT before radiation to weaken the cancer before hitting it with radiation.

Best wishes to you...

[JPnSD]

Thanks all. The San Diego IPCSG.org group just held a zoom meeting with Dr. Carl Rossi and Dr John Einck of UCSD and Cal. Protons. Very informative. I like the idea of the reduced GI and GU toxicity and reduced ED impact for SRT using PBT..versus IMRT. The only issue is insurance coverage. The presentation will be on You Tube later today.