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BCR Prostate cancer. Need Opinions

Posted by sarge73 @sarge73, 6 days ago

Hi thanks for reading. Here is my story:
Grade 1 Gleason 6. PC doubling time 67 months.
2003 Radical Proctectomy. For over 10 years my PSA was < 0.1. In the 11th year it went to 0.3 then bounced around 0.3 to < 0.1. Then up to 0.3 for 9 years. Recently my PSA went to 0.48 then back down to 0.42.
PSMA was negative.
My urologist says let's keep an eye on it. I went to a Radiology oncologist, and he told me three options. Watch it, Radiation only or Radiation with Lupron. Both indicated if I am going to have Radiation now is the time.
My concern is the side effects of radiation and Lupron. But if I wait and let it rise, I will miss an opportunity for a possible cure.
Any thoughts what I should do and your thoughts on side effects?
Thanks so very much!

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icorps | @icorps | 4 days ago

Depending where it's located, and given the relatively very indolent nature of your PC, you might consider radio treatment of SBRT. That may include a slight dose of ADT 3 or 6 months. It's thought by many radiologists that the ADT kind of radiosensitizes the cancer to the radiation dose (kind a like softens it up). Not all agree and the issue is now a subject of clinical trials.
You can Google the subject. Lot's out there on this.
In any event the short term ADT I had in connection w my salvage radiotherapy wasn't that bad. I think the key is staying with an
Intense workout regime before, during, and after.
Good luck!!!

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sarge73 | @sarge73 | 4 days ago

Wow thanks for the extensive feedback. It's a tough decision! You are very kind

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sarge73 | @sarge73 | 4 days ago

Wow thank you so very much! Its greatly appreciated.

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sarge73 | @sarge73 | 3 days ago
In reply to @kujhawk1978 "Well, with the clinical data you describe, doing nothing, or what I call actively monitoring through..." + (show)
@kujhawk1978

Well, with the clinical data you describe, doing nothing, or what I call actively monitoring through continued labs and consults is an option. I mean GG1, GS 6....

You can plug your lab values into MSKCC nomograms to gather additional data in making a decision - https://www.mskcc.org/nomograms/prostate

You can image with a PSMA PET, it may or may not locate recurrence.

If after gathering all the additional clinical data and discussing with your medical team, the decision is to treat then you have choices:

the PSMA PET is positive, you can do SBRT only to the identified location(s) and then see what happens. There is discussion about SBRT used as Metastatic Directed Therapy delaying the need for systemic (ADT) therapy. Think of it as "spot welding" or "whack a mole."
You could add short term ADT to the SBRT- as others have said, use Orgovyx vice say Lupron. The advantages are:
No flare
Faster to castration
Higher sustained castration rates
Lower CV side effect profile
Faster recovery of T when stopping
No trek to the doctor's office to get the shot, of course, if you get the six months shot vice say a 90 day one...

It does require self-discipline to take it every day and there may be financial toxicity associated with it depending on your insurance. The side effects of no T are familiar, the severity is the question. I've done both, Lupron and Orgovyx, going to say qualitatively, the severity of the side effects were less with Orgovyx.

If the PSMA PET is inconclusive, what then?

Well, back to the do nothing option,,,
Or,,,
You could do radiation to the prostate bed only- SRT
You could include the WPLN with the SRT to the prostate bed.
You could either of those and include short term systemic therapy

Another factor is life expectancy, some studies point to eight years or more before metastases develop.

I have had SRT, WPLN and SBRT, zero side effects, testimony to the advances brought about by medical research in planning and delivery of radiation as well as my radiologist and her team.

Keep in mind statistics, Bell Curve, Standard Deviations, Mean, Mode, Average, Linear Regression. There are guidelines such as the NCCN, AUA. they are based on science but are population based and may lag behind data emerging from ongoing medical research.

The art of medication is applying the science to your PCa.

I can't "tell" you what to do, that's a discussion between you and your medical team. There is no "right" decision from my experience, only good decisions based on the clinical data and the tradeoffs between one decision and another. When faced with a decision, we can easily get mired in "paralysis by analysis...!"

If that was my clinical data, I would do nothing, continue to do labs and consults, wait for a definitive rise in my PSA, three or more consecutive ones spaced three months apart, image between .5-1.0, then decide. In the interim, I would just go about my life, free of the side effects of ADT!

Kevin

Jump to this post

Hey Kevin, May I ask you a question. In your opinion if I just watched it and a time came that I needed to do something when you say decide, do you mean radiation Adt for life etc? Thanks for your expertise

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kujhawk1978 | @kujhawk1978 | 3 days ago

Hard to see into the future.

That being said, here's my thoughts based on your clinical data.

If your PCa recurs, I venture it is most likely oligometastatic, low volume.
If imaging locates the recurrence your medical team may suggest one of two options...

If you don't want to do ADT, they may suggest MDT in the form of SBRT to the sites identified in the scan.
If you are ok with some ADT, most likely they may suggest SBRT for MDT and 6-12 months of ADT for micro-metastatic PCa. This course of action may bring a longer progression free survival period than SBRT for MDT only.

I do not see ADT for life given your clinical data.

Then again, by the time you face a decision, who knows what changes medical research has brought about!

In the meantime, enjoy your life!

Kevin

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2 replies
kujhawk1978 | @kujhawk1978 | 3 days ago
In reply to @kujhawk1978 "Hard to see into the future. That being said, here's my thoughts based on your clinical..." + (show)
@kujhawk1978

Hard to see into the future.

That being said, here's my thoughts based on your clinical data.

If your PCa recurs, I venture it is most likely oligometastatic, low volume.
If imaging locates the recurrence your medical team may suggest one of two options...

If you don't want to do ADT, they may suggest MDT in the form of SBRT to the sites identified in the scan.
If you are ok with some ADT, most likely they may suggest SBRT for MDT and 6-12 months of ADT for micro-metastatic PCa. This course of action may bring a longer progression free survival period than SBRT for MDT only.

I do not see ADT for life given your clinical data.

Then again, by the time you face a decision, who knows what changes medical research has brought about!

In the meantime, enjoy your life!

Kevin

Jump to this post

For example....https://www.medpagetoday.com/hematologyoncology/prostatecancer/114510?xid=nl_mpt_DHE_2025-03-05&mh=cd5afc56c7824ea088c90f7a50fbc9d5&zdee=gAAAAABm4u-ja7YdVFigDJb1rzW3z6sbs3KwAxcMsIbHv-XeCLQDUasqRFvYC82HW97i9PfpKNMFvKYo-wJtCAzyO-rFRJ7uiawjSDMUQx6AP0-mwaxBR44%3D&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%20-%20Randomized%202025-03-05&utm_term=NL_Daily_DHE_dual-gmail-definition

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1 reply
sarge73 | @sarge73 | 3 days ago

Your the best man! Thanks

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sarge73 | @sarge73 | 3 days ago
In reply to @kujhawk1978 "Hard to see into the future. That being said, here's my thoughts based on your clinical..." + (show)
@kujhawk1978

Hard to see into the future.

That being said, here's my thoughts based on your clinical data.

If your PCa recurs, I venture it is most likely oligometastatic, low volume.
If imaging locates the recurrence your medical team may suggest one of two options...

If you don't want to do ADT, they may suggest MDT in the form of SBRT to the sites identified in the scan.
If you are ok with some ADT, most likely they may suggest SBRT for MDT and 6-12 months of ADT for micro-metastatic PCa. This course of action may bring a longer progression free survival period than SBRT for MDT only.

I do not see ADT for life given your clinical data.

Then again, by the time you face a decision, who knows what changes medical research has brought about!

In the meantime, enjoy your life!

Kevin

Jump to this post

By the way how do you know so much about this! Forgive my ignorance. MDT?

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1 reply
kujhawk1978 | @kujhawk1978 | 3 days ago
In reply to @sarge73 "By the way how do you know so much about this! Forgive my ignorance. MDT?" + (show)
@sarge73

By the way how do you know so much about this! Forgive my ignorance. MDT?

Jump to this post

I've been at this 11+ years, high risk, four different treatments..

In part, my life has depended on my actively involvement in discussions and treatment discussions and decisions with my medical team.

When I was diagnosed and my urology was going over the biopsy report with me, he finished "explaining" the results and his recommendation, then closed with "what questions do you have?"

I mused for a second, said no...what I really wanted to ask was"what's a prostate!!" I didn't, despite the "there's no dumb question mantra, there is!

That was my level of knowledge when I started...!

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