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IMRT Radiation/ADT after surgery?

Prostate Cancer | Last Active: Mar 25 9:41am | Replies (12)

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Kevin thanks for your reply. I have read many of your posts/comments on this site and you seem to have done your homework. Suggested radiation to prostate bed, and pelvic bed due to one of 12 lymph nodes removed was cancerous. ADT to be determined on 4/2/24 appointment.

I should add that my treatment is at Loma Linda University, Loma Linda, CA.

In my post I was hoping to find someone with my numbers to see what treatments were used, if any and the outcome.

Thanks again Kevin for taking the time to comment, informative and appreciated.

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Replies to "Kevin thanks for your reply. I have read many of your posts/comments on this site and..."

ok, one part of your treatment decision is decided based on clinical data, IMRT to the prostate bed and WPLN.

In both my ADT stints, Kwon in 17-18 and my current oncologist in 23-24, they decided not to add the ARI since treatment dropped my PSA to undetectable and it stayed there while on treatment. While aggressive in their approaches, they did not want to overtreat.

Things have changed (imagine that...) since my diagnosis and GS has morphed in groups:

Grade group 1: Gleason score of 6 or lower, which is low-grade cancer
Grade group 2: Gleason score of 3 + 4 = 7, which is medium-grade cancer
Grade group 3: Gleason score of 4 + 3 = 7, which is medium-grade cancer
Grade group 4: Gleason score of 8, which is high-grade cancer
Grade group 5: Gleason score of 9 to 10, which is high-grade cancer

You're a 3, so, intermediate risk...the infamous gray zone, do I, do I not... I'm a four, made my decisions easier, particularly with that PSADT

Early in 2019, my PSA jumped to .36. That was my first USPSA with the new urologist, I was ready to hit the treat button, ASAP...! I took a deep breath, asked him to repeat after two weeks, then .124, and .06. Then you see it rise and fall again until 2022 when it began its continuous rise. I could have treated, he would have done what I asked, but with the variability I set some ground rules:
three or more continuous and significant rises spaced 2-4 months apart.
same labe, same time, same pre-draw routine
we would not image until PSA was between .5-1.

In March 2023, had criteria was met. Had I reacted to the increase in 2019, I would have started treatment four years earlier than maybe needed.

The other interesting thing is my testosterone.

Mine recovered quickly and higher than my baseline (287) going into triplet therapy. Oct 18 135, Feb 19 432 and by Apr 23, 610. So, if T is the fuel for PCa, should I not have had recurrence around Oct 18, certainly Feb 19 when T hit 432...or shortly after!

You can find arguments either way, treat early as you and your medical team are contemplating, or not necessarily now, later. Questions you may never know, if we treat now, does that change the outcome, cure, progression free survival, overall survival...? If we treat later, same questions but you will have enjoyed longer time off treatment and the outcomes still the same...

We want a checklist to follow, unfortunately with the plethora of treatment options comes an equivalent plethora of decisions with unknown variables in terms of outcomes. Medicine, part science, part art...

I don't think you can necessarily make a "wrong" decision. You make the best choice based on the clinical data you have, your priorities, financial toxicity,...and go from there when you see the results. In business case studies, they call the past "sunk costs" or irrelevant to the decision today!

Let the forum know what you decide and your progress on treatment and after you come off.