ipp and salvage radiation

[Katamiran]

Rp on july of 22 for gleason 3+4 with psa of 16. PT3b, pN1 with negative margins and 2 of 11 lymph nodes involved. I took a nomogram online and came out 75% likely for recurrence. My first psa post op was .02, then .03, .04, .04, .05 in late august- so I've crossed line #1. Which is a bummer but not a surprise.

I'm 68, very healthy and fit otherwise, and my only lt side effect has been serious ED. I've done the bi and trimix route and had no success. I still want that part of my life, and scheduled surgery for the implant at the end of this month before the latest test results.

To my questions: Will the implant interfere with the probable salvage radiation I may need in the middle future? if not, any feedback from you all about the surgery and the results? Anyone with complications, or who had to go on ADT and found it to be not worth it? Any other comments that are pertinent? And as a possibly meaningful aside, my T level pre surgery was 1116; feels like it's still pretty far up there😉.

[Tall_Allen]

You will require at 3 years of ADT and 2 years of abiraterone, as well as an expanded radiation field. You may want to wait on the implant until afterward.

[Katamiran in reply to Tall_Allen]

That sounds like a tougher salvage menu than most I've seen on here. What in the pathology makes you come to that conclusion? Neither surgeon (prostatectomy or ipp) has mentioned the implant being a problem. Would the device interfere with radiation?

I'm hoping I'll have a bit more time before launching retreatment. I've followed the debate between .05,.1, and .2 start points. Are you forseeing one more than the others?

[Tall_Allen in reply to Katamiran]

You seem to misunderstand your situation - the debate "you've followed" has nothing to do with men in your situation. When there are positive lymph nodes, one should begin radiation immediately, and not wait for PSA to rise.

ascopubs.org/doi/full/10.12...

As you can see, for men with positive lymph nodes, the 10-yr death rate was cut in half by getting immediate radiation. For men who waited until PSA rose to 0.2, the 10-yr death rate was no different than if they had no salvage radiation whatever -- the cancer cells had already escaped.

The extensive use of adjuvant ADT for men with positive lymph nodes was proved in a STAMPEDE trial:

ncbi.nlm.nih.gov/pmc/articl...

[Lost_Sheep in reply to Tall_Allen]

I know that waiting a while before implant (up to two years) is considered worthwhile because erectile function may return over time. Is there any other reason?

[Katamiran]

Picture me gobsmacked. Reading these is the first time I've heard the phrase high risk in relation to my situation. I do indeed appear to have misunderstood my situation, as have the professionals I've been relying on, even if this even partly applicable. I'll be getting in touch with Skyler Johnson in SLC immediately and I guess start looking for an MO, and changing my life plans.....

Thanks for the kick in the butt; wished I'd asked sooner.