urologist and radiation oncologist aren't on the same page

Sorry to hear that- have you been able to find an oncologist that has a deep understanding of PC ?

Is your PSA < .1 right now on Eligard?

Where are you being treated? Staying on ADT alone would just not be a great idea. I was on it for eight years, but it stopped keeping my PSA down after 2.5 years (became castrate resistant), After that, I had to go on abiraterone which got it back down for 2.5 years.

Where on the PSMA scan results did they find cancer? Is it only in the area of the prostate?

What kind of radiation did you have the first time? Did they leave some of your prostate untreated after the surgery ?

The seeds would be good if the cancer is isolated to that area. If it has spread to other areas you could get SBRT radiation on those spots as well.

You could try to get a decipher score, which should show whether or not it’s likely for your cancer to become more aggressive. It tells you a little bit more than what a Gleason nine means, as far as aggressiveness goes.

Here is what the NCCN (National Comprehensive Cancer Network) 2025 Guidelines state:

Local Secondary Therapy for Recurrent Prostate Cancer After Definitive Radiotherapy:
• Patients with biopsy-proven recurrence in the prostate after prior RT and without distant metastatic disease can be considered for local
therapy.
• The Panel recommends that patients receive multidisciplinary counseling about the risks and benefits of each of these options in the context
of the available comparative literature on this topic.1,2
• Local therapy options for patients with recurrence in the prostate only include:
RP + PLND
Non-surgical strategies
◊ Cryotherapy
◊ High-intensity focused ultrasound (HIFU) (category 2B)
◊ Reirradiation

• Local therapy options for patients with recurrence in the regional nodes with or without prostate recurrence include:
ADT + pelvic lymph node radiation (if not previously done)
ADT + pelvic lymph node reirradiation (category 2B)
ADT + PLND (category 2B)
Pelvic lymph node radiation
PLND
• Reirradiation options include LDR brachytherapy, HDR brachytherapy, and SBRT.1-7
• There is no consensus as to the most appropriate reirradiation volume, and there are published experiences for both focal/partial and whole
gland reirradiation. The Panel recommends that patients receiving local therapy for RT recurrence are treated within the context of clinical
trials when available and/or at experienced centers.

Stay Strong Brother, we got this.

wsa, my oncologist had the same kind of prostate cancer about 15 years ago. I don't know how qualified that makes him, but I assume he was personally motivated to do some homework.

jeff, the PSAM identified cancer only in the prostate area.

I had radiation (about 30 sessions) 4 years ago. No surgery.

Both doctors say that a Decipher is not relevant for my case.

From the beginning, my cancer was described as "high grade aggressive"

I need to track bluegill future medical treatments. His case is worth studying for education to all of us.

Gee, thanks. I think.

I'm considering going for a third opinion from a different hospital (Mayo?).

Never hurts to get a third opinion. My personal feeling is that you should do focal radiation therapy - seeds, SBRT….
The cancer that remains in your prostate is obviously a hale and hearty one. Lower levels of radiation - and 3 years of ADT - did not control it so now you really have to hit it hard to kill it. I feel you are getting a second chance to obliterate it. ADT didn’t work and going forward castrate resistance becomes an issue; stay on it for life?? Don’t think so…

I agree with @heavyphil. A third opinion does not hurt. Here is the name plus info of one of the 5 that I got an opinion from. He is at Memorial Sloan Kettering and did a telehealth for me:
https://www.mskcc.org/cancer-care/doctors/himanshu-nagarheavyphil

Hey Bens1, Dr Nagar is great. I consulted with him 6 yrs ago when he was at Weil Cornell. He was one of the few RO’s using the Meridian system for SBRT , which I think you had, right?
He was very confident that he could treat my case, but I opted for surgery since the technology was still fairly new. I owned a few thousand shares of stock in the company, lost $$, but sold before they went bankrupt😂.
This MRI guided treatment is fantastic IMO and much better than Cyberknife because of less marginal tissue damage. It would be an excellent choice for @bluegill since NO fiducials are necessary and the remaining tumor tissue can be destroyed with no excess radiation to the already irradiated gland.

@bluegill
Wow! First my empathy with such a disagreement when you are already on stress.

Per my urologist and R/Os the hormone treatments do not kill your prostate cancer. The inhibit from growing.

Radiation damages the prostate cancer and they cannot repair themselves and die. Some treatments actually kill the cancer cells not just damage them. Again from my urologist, and R/Os and try researching information also.

The Gleason score numbers are subjective. Tests like decipher are more precise.

ADT has for many serious side affects. Radiation has side affects but for most very minor and easy to deal with. I had minor side affects that were easy to deal with with some life style changes and slowly went away.

Have you considered getting a third opinion?
Good luck!