3 month PSA post RT/ADT, low enough?

[sptill72]

51, diagnosed at age 50 (Pirad 5 w/ ECE, 3+4 (20%), PSA 10.1, negative PSMA, Decipher high 0.84). I received SBRT treatment at UCLA in late October, 2023 (finished 10/25). I’ve been on ADT since October 16, 2023 and am scheduled to end ADT this March. I had my first follow up PSA test on 1/19 and it was 0.5 and my testosterone was 19. I was initially happy with the result but after reading a number of studies it sounds like 0.5, three months post RT/ADT, indicates a less favorable outcome. I have follow up appointments this week with Dr. Kishan at UCLA and Dr. Lam of Prostate Oncology. Am I jumping the gun or should I be concerned that this almost three month follow up PSA isn’t low enough? I’m tolerating ADT pretty well so I’m not opposed to extending the duration if necessary. I’m also wondering what other treatments could be added to the ADT (drugs, pelvic radiation) to improve the outcome? I want to make sure I’m asking the right questions. I feel at 51, I need to hit this as hard as I can now before it gets out of control. This message board has been such a help and I really appreciate any feedback.

[Tall_Allen]

I'm not sure that 6 months of ADT is enough for your high-risk (ECE, Decipher) PCa. Consider adding apalutamide and staying on it for 2 years.

[sptill72 in reply to Tall_Allen]

Thanks TA. I will ask about this. Dr. Lam initially mentioned in an email not to worry too much about PSA for a few months after RT, even w/ ADT. However, the studies seem to indicate it's a major indicator of future issues. The high decipher combined with the PSA is what concerns me most.