I need advice to help make a decision.......

Maybe I shouldn't answer your question. I'm one of those people who if the doctor says we are doing this, then I am on board. In my opinion he has more knowledge then I do. In your case he left the decision up to you. I'm not sure how I could handle that. That would give me lots of anxiety. I'm on adt but haven't had to have the radiation treatment up to this point. Maybe I should of just let this one go. I wish you the best on your journey.

Honestly, I agree with all of your points.
Why wait for possibly cancerous cells to get bigger? Zap 'em while you can.

I had a prostatectomy 7 weeks ago, with clear margins & no lymph node involvement.
The prospect of bowel & bladder incontinence is no fun, but if it was me, I'd nip it in the bud.

/2 cents

We'll wait for others who have actually had to make that choice.
Keep us updated either way. I'm sure it'll work out well for you.

I tend to agree. They're experts because they spent years studying this stuff - we didn't.

There's not a right answer, just a preference: you tell your onco team how you want to approach it, and then they help you figure out the details.

In my case, there was no @#$%@ way, I was going to sit down and let stage-4 cancer take over at age 56 (back in 2021), so I told them I wanted to fight, and then they told me they'd "throw the kitchen sink at it."

If I'd told them that I was already struggling because of the spinal injury and post-surgery complications (which I was), and didn't think I could face anything else (not true; I was ready to come out swinging), they would have helped me come up with a plan for that instead.

So the fact that *you* want to fight is your answer. The only remaining question is "how?"

I agree with your proposal and that is what I would do. Waiting until the cancer comes back and is stronger is not a wise choice. Good luck

I really don't have anything to add to the excellent comments already provided on this thread regarding the decision you need to make. However, I would suggest that being reasonably confident with whatever treatment path you choose will be important to your emotional well being as you go forward. Since you're not entirely sure which path is best for you (and I certainly don't know as well) I'd suggest getting a 2nd or even 3rd opinion (preferably from a recognized cancer center of excellence). It might give you an additional degree of confidence in whatever path you choose so you can be at peace with it and not have any regrets later. Best wishes to you and yours.

The recent seminar I went to shows that intraductal is aggressive and usually means you have cribriform. Because of that doing something makes more sense.

I wish you had mentioned what your Gleason score is. And also a decipher score if you have one. The Gleason score tells you how aggressive it is. If it’s above seven then you are aggressive along with the intraductal aggressiveness is even a little higher. This disclosure about intraductal being so aggressive is sort of new news. I will be posting a link to the video of that meeting when it becomes available.

Yes, you could wait until your PSA hits .2 to do the salvage radiation. As they said the results are the same. With other issues, metastasis could appear while you’re waiting, but at .2 there won’t be a lot.

I’ve been on ADT for eight years. In my case, I don’t get the fatigue. I do get the hot flashes and brain fog and loss of muscle. Going to the gym three days a week now to try and rebuild my muscles. If you start weight training when you begin ADT, you may not lose too much muscle. I am 77 and not overweight, I keep a very tight lid on my weight. Some people gain weight with ADT, you don’t have to.

I would avoid ADT as long as you can. In my case, I had radiation3.5 years after surgery and was not put on ADT until my PSA started rising again 2 1/2 years later. They didn’t know I have BRCA2 15 years ago when I was diagnosed, just found out two years ago,. My PSA was 4+3 so not too aggressive, that didn’t stop PC from coming back four times.

Wish you luck.

Sorry that you are hear, but glad you are thinking and asking questions, nicely done!

my take on your situation would be the following:

> PSA tests every six weeks for the foreseeable future
> Perform a genetics test before making a decision on next steps
> Lean into radiation with the mindset to seek and destroy the cancer in the lymph node(s)
> When PSA rises, perform a PSMA PET scan
> Using the scan results, re-apply radiation, assuming Oligometastatic cancer
> Begin ADT after PSA has risen and radiation is not seen a solution

The choice to begin ADT now (with radiation) is definitely an excellent standard of care and I see nothing wrong with it and support it, but ADT is no joke, it requires vigilance to manage the side effects. Some do it well, others not so much.

Please keep us posted and continue to recovery from your surgery, hopefully all is well!

I had Salvage Radiation Treatment w/ short term ADT beginning 6 mos after RP.
Aug 2022 - RP at age 72
Excellent postop recovery.
Margins, lymph nodes and seminal vesicles clear.
However, pathology confirmed G 9 and found extraprostatic extension (EPE). Both are negative factors.
1st PSA test 90 days postop .19 (reconfirmed 30 days later .18)
Radiation Oncologist in December recommended 37 IMRT radiation txs 66.6 gy to whole prostate region (WPRT) and 25 of those sessions 45 gy included the pelvic lymph nodes.
Also recommended 4 mos STADT, I chose Orgovyx.
Began ADT in Feb and radiation in March.
Completed radiation in May and ADT in June.
6 mos after completion of radiation uPSA < .02, undetectable.
uPSA has continued undetectable 3 additional tests and actually waiting for results this week from 5th 90 day testing period.
TBC

At age 71 your personality is not going to change - mine hasn’t. If your gut is telling you to treat now, then just do it.
The studies are correct: No statistical difference in treating now or 5 yrs from now. As long as you are monitored with 3 month PSA tests your cancer - if present - should not spread our of the prostate bed.
But can your personality handle .01 or .02 rises in PSA every 3 months? Or a sudden rise by .04 that then drops at the following test? That’s the real question IMHO.