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PSA detectable 18 mos after prostatectomy

Prostate Cancer | Last Active: Jan 12 5:42pm | Replies (35)

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@kujhawk1978

Here's my clinical history.

After surgery in 2014, I had BCR. At the time, the standard of care was SRT to the prostate bed. Yet, there was data and evidence emerging from CTs and Mayo that including short term ADT and extending the radiation to the pelvic lymph nodes was a better option since they were finding more often, BCR actually included disease outside the prostate bed.

I discussed this with my radiologist and urologist, they dismissed the idea, no long term data they said, not in the NCCN guidelines, wasn't mainstream clinical practice. I acquiesced and you can guess the rest of the story, I was right, too bad I was.

So, starting point would be to familiarize yourself with the NCCN Guideines - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

You can also do literature searches on doublet and triple therapy - https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc

Next, the forum will need your clinical data, pathology report for example to provide you feedback. The answer in part lies in your risk category.

All that being said, you'll have choices, what you choose will in part be what your medical team recommends and in part what's important to you - going for a cure, quality, quantity of life, financial toxicity associated with treatment...

You could do nothing, there is some data that says it may be up to eight years before you have metastases, remember, risk category!.

You could do treatment to the prostate bed only, radiation, there are plenty of choices there too, IMRT, SBRT...

You could be aggressive, do SRT, extend it to the PLNs, add short term ADT, say six months.

If not already, you may want to add an oncologist to your team to get further medical input (I am not a medical expert!)

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Replies to "Here's my clinical history. After surgery in 2014, I had BCR. At the time, the standard..."

Mine was .23. 4 months adt and sbrt to whole pelvic area including lymph nodes.

No real reason to wait. .2 to .4 sweet spot for success.