Had Radiation and adjuvant ADT for 16 months now what?

[binati]

I am 74 years old. I was diagnosed in Apri 2019 with PCa, Gleason 10, at a PSA of 250. A Ga68 PSMA Pet Scan showed there was no spread or metastasis visible. However, it was the considered opinion that there would be mets in the lymph nodes nearby which were too small to be visible on the PSMA Pet Scan. As per advice of doctors I started ADT with Firmagon in Jun 2019 and in Nov & Dec 18 had 78Gy (39 sessions) of IMRT covering Pelvic Nodes, Prostrate etc. At the time of the RT the PSA was 1.5. It is currently at 0.079 after 18 months. The doctor wants me to continue on Firmagon for 24 months after the IMRT as a high risk case. It seems to be the SOC for high risk cases.

I have been very regular in walking and exercising including some light weights. My last DEXA scan shows some thinning of the hip joint but other areas are still okay. However, I am taking Ibanduric Acid monthly. Other blood parameters seem to be okay so far.

My concern is that what should I do now? Should I stop ADT after 24 months? Should I add a second generation ADT to hit it hard or get chemotherapy? Is there a better course of action? I am at a loss. I am in India and have access to all the medication.

[Tall_Allen]

" Should I stop ADT after 24 months?" A recent study found that 18 months is as good as 3 years for adjuvant ADT. It is reasonable, given your high risk characteristics to go a little longer.

meetinglibrary.asco.org/rec...

"Should I add a second generation ADT to hit it hard?" Maybe. A recent study suggested quite a benefit.

urotoday.com/conference-hig...

"or get chemotherapy?" Maybe. It doesn't add a lot, but again, considering your high risk characteriatics, it is worth considering

ascopubs.org/doi/10.1200/JC...

urotoday.com/conference-hig...

[jjpeabody]

Thanks for sharing binati. For your age and degree of disease it sounds like your doctor knows what he is doing. Did you have incontinence or toxicity as a result of the IMRT. Good luck.