Prostate cancer recurrence: RT advised concerned about quality of life

I would ask my physician about ADT and Erleada and if that did not work do radiation. Your doctor might have a good reason to use radiation first, but that can be a higher incontinent risk. Also, a second opinion might be in order. Good luck.

I would seek a consult from an oncologist first to what your treatment options are. I would also suggest an Mri ,that might be more sensitive. Did your pet/ct include a tracer ? Mine did.

waynebarry @waynebarry, You might want to post this in the "Prostate Cancer" group

Welcome, @waynebarry. I moved your question to the Prostate Cancer support group here https://connect.mayoclinic.org/group/prostate-cancer/ as @dandl48 suggested. I hope you saw the responses from @nicholas7 @hbp as well.

You are most definitely not alone. Members have talked about recurrence years after the original diagnosis and making treatment choices.
See the complete list of related discussions here: https://connect.mayoclinic.org/group/prostate-cancer/?search=recurrence&index=discussions

Did your cancer team talk about options with androgen deprivation therapy (ADT)? What treatment did you have 10 years ago?

Does Mayo offer the Choline Pet/ct at all locations?

You mentioned that your “PET/CT TEST was negative.”. Which specific PET scan did you get?

Well...,

You may not need to rush to a decision.

Thank your urologist for the input, now consider seeing a radiologist and medical oncologist, preferably ones who specialize in prostate cancer.

At that PSA, no surprise the PET/CT came back negative.

If possible, ask for one of the PSMA scans. I had the Plarify in March 2023, it showed a single pelvic lymph node. Based on that and my clinical history we did SBRT and 12 months of Orgovyx for micro-metastatic disease too small to be seen by imaging but knowing it was there, somewhere! I just came off treatment on Thursday after discussion based on my clinical data with my oncologist and radiologist, I am under no illusions of a "cure (don't get me wrong, I'd take it!)" but looking for three to five years progression free period, then we'll see what's next.

One factor in your decision is your current state of health and life expectancy. I mean, some studies will say it may be eight years until metastases show up, you're 83...of course, that's statistics, so do you want to chance that you're in the "average!?"

As to the incontinence, radiation treatments have come a long way...I've had three rounds:

March 2016 - SRT 39 IMRT 70.3 Gya to the prostate bed only.
July 2017 - WPLN 25 IMRT 45 Gya
April 2023 - SBRT 5 x 8 Gya

Not a single side effect, a tribute to the training, education and experience of my radiological team *same ones each time) and the technological advances in the planning and delivery software and hardware.

If you treat based solely on PSA you have options:

SRT to the prostate bed only (as your urologist suggests)
SRT to the prostate bed and short term ADT, say six months
SRT to the prostate bed, extend the treatment to the PLN systems, the whole PLN
SRT to the prostate bed, extend the treatment to the PLN systems, the whole PLN and short term ADT.

The answer lies in how aggressive you want to be. As to the SEs, not dismissing.

The PSMA PET may inform your treatment decision (does not necessarily change your treatment options), providing a radiologist a target(s) to radiate vice bindly treating the prostate bed (think smart vs dumb bombs). As to the ADT, hey six months and is you use Orgovyx vice say Lupron (depending on your doctor, insurance), coming off it is faster than Luron, or at least I"m about to find out!

Give your time to BCR, age (not trying to say old..!), not sure your medical team would consider doublet or triplet therapy by adding an ARI such as Xtandi, or including chemotherapy, seems too aggressive.

Another piece of the clinical data puzzle would be one or two more PSA tests which could provide PSADT and PSAV, if PSADT:

> 12 months - option to just "monitor"
6-12 months, kind of like GS 3+4, what to do.
< 6 months - decision to treat or not just made for you.

Treatments are generally a risk-benefit decision, combining clinical data, side effects...and your personal priorities.

Kevin

thank you, ill run it by the doctors

f18 PSMA

That being the Pylarify PSMA PET scan, and that result being negative, how are they confident that recurrence is in the prostate bed and not elsewhere? In Dr. Kwon’s presentation about recurrence, he indicates that following prostatectomy, only 33% of the time is recurrence only where the prostate was and that you should be absolutely certain before doing salvage radiation there.

Since nothing is showing with your PSMA PET scan (and you don’t want them blindly hitting you with radiation), ask if they can use an earlier type of PET scan that doesn’t rely on PSMA expression to find the cancer, perhaps an Axumin PET scan or a C11 Choline PET scan?

You still have options. Hopefully, they’re willing to work with your concerns. Good luck!