You'll find a range of treatment options...

There is debate about whether or not SBRT by itself can be "curative."

Most literature I've read leans towards SBRT by itself as "palliative," used for PCa control, delaying the need for ADT.

With a single lymph node SBRT may very well control the PCa, have a period of radiographic progression free survival, I've seen literature that says it can be used in up to 3-5 metastases.

I've also seen literature that equates to "where there's smoke, there's' fire...!" That just means micro-metastatic PCa imaging can't see.

If so, ADT can be added. More questions to ask and answer, how long, which agent, do you add an ARI....the answer may lie in your other clinical data, Gleason Score, Grade Group, PSADT and PSAV, time to BCR.i am high risk, GS8, GG 4, PSADT around three months, 18 months to BCR...so we did SBRT and 12 months Orgovyx. Oncologist wanted to do 24 months and add ARI (EMBARK). I was thinking six so 12 was a compromise between he and I. We also agreed to hold the ARI and only add if PSA did not drop to undetectable in the first three months, it did.

My radiologist supported six or 12, said in the tumor board reviews the oncologists were all over the map about duration of ADT, adding ARI.

You still get all the wonderful side effects with Orgovyx, I mean no T is exactly they whether Lupron or Orgovyx. The recovery is a hell if a lot quicker though!

The VA's proposal is a definite no!

Kevin