RT and ADT for High Risk PCa

[binati]

In Apr 2018 I was diagnosed with PCa Gleason 5+5 and PSA of 250. PSMA Pet Scan showed tumour only in Prostrate with one ECE and Seminal Vesicles involvement. There were no Nodes visible and no mets. I immediately was put on Firmagon in June 2018. This was followed in Nov/Dec 18 with 44 sessions of 78 Gy of RT through IMRT. I continued to be on Firmagon for 24 months. My PSA came down from 250 to 0.04 by Dec 2020. Since then it remains at 0.04. My oncologist wants me to be on ADT for another 12 months. She is also insisting on my getting a PSMA Pet Scan though I told her that it would show nothing of value especially at PSA of 0.04. Any advice folks?

[Justfor_]

I would take the PSMA pet scan. Those claiming that nothing will be detected bellow some magic number ( there are 3 of them namelly 0.2, 0.5 and 1.0) are ignorant/allergic to continuing education who basically don't have a clue regarding how things function in nature. Binary logic (0 or 1) is a good foundation for our digital world, but not in the single bit domain. More than one century ago Samuel Morse came up with his telegraph code. Even Morse's code isn't a single bit code because the pauses between dits and dashes forming the letter symbols carry ancillary information, like a word or a sentence start. Then came Telex, a 5 bit code. Ultimately, the first computers started from a handful of bits to today's common place of 64 bits. Technology has traveled a long way to mimic nature's analog function within a digital environment. Said docs live in the pre-Morse era.

[Tall_Allen]

I agree with you, that you have no chance of seeing any new metastases on a PSMA PET scan right now. Since you have a very high PSA type, PSA will be your best indicator if there is any progression. Save the PET scan for if you have PSA progression.

I assume you received whole pelvic radiation and not just radiation to the prostate itself. You should also discuss the questions posed at the end of this article:

prostatecancer.news/2021/06...

[binati in reply to Tall_Allen]

Yes I received radiation to prostrate bed, prostrate and pelvic nodes.