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[hg115pb]

Hi all. The information shared on the forum has been very helpful in understanding options and sharing experiences of others. I was recently diagnosed via a jump in PSA to 10.4. MR fusion biopsy Gleason 4 +3. Had RP in January confirming the Gleason score, with positive margin T3a, and 1 node with a 1mm focus of tumor. Am otherwise pretty healthy, started Casodex (for flare), Eligard, and Zytiga, and RT to commence in another 6 weeks or so. The Eligard and Zytiga recommended for 2 years. Has anyone with a similar picture added a third drug for the 2 years? I looked at the protocol GU008 that combined Lupron plus Zytiga plus Erleada in node positive patients combined with RT. I guess rationale to hit it as hard as possible up front. Anyone have experience with this trial or combination? So far feeling ok but it has only been a few weeks, hot flashes and fatigue primarily.

[Justfor_]

How is your continence? RT will set you back in this regard. Six to nine months of healing period after RP is usually recommended.

[hg115pb in reply to Justfor_]

Continence has been well preserved. My surgeon, MO and radiation therapist recommended we start at the 3-4 month interval given my progress post op

[Justfor_ in reply to hg115pb]

I find it extra risky with no gain to be anticipated, as you already have started ADT, but it is your anastomosis that will have to cope with the radiation.

[Tall_Allen]

Good plan! I'm sure your RO knows that the recommended radiation field has been expanded to include the common iliac LNs.

[hg115pb in reply to Tall_Allen]

Yes We reviewed the fields and the commons will be covered.

[Jmr11820 in reply to Tall_Allen]

Allen, curious if you still advocate for no

ADT with RT in PT3a with PSA<.05? Assuming negative nodes.

[Tall_Allen in reply to Jmr11820]

Why would you have salvage radiation at all with undetectable PSA?

[Jmr11820 in reply to Tall_Allen]

Well, for me, after RP showed adverse pathology, high Decipher and then PSA moved from . 01 to .03 in 4 months... I chose RT with no ADT, based on a study by Spratt that you and others have cited. But a more recent study that Spratt was involved in showed high risk Decipher patients, even low PSA, with a better survival outcome with ADT with RT. Thought you might shed some light.

[Tall_Allen in reply to Jmr11820]

That is only IF you need SRT in the first place. No one thinks that with a PSA of 0.03 anyone needs SRT, Decipher or no.