BCR Prostate cancer. Need Opinions

Forgot to add, MDT is metastases directed therapy.

In layman's term, treatment targeted vice systemic.

Thanks! Here is my delema. Both the oncology radiologist and urologist told me if I'm going to do this I'm at the sweet spot PSA for possible cure. If I wait it's more difficult to cure. I also read this. I hate this man. I thought I was done 22 years ago.

They are not "wrong."

Most of the literature I've seen over time discusses .3 or lower as being the curative "sweet spot."

So, maybe .3-.5 is curative too?

It is a dilemma, we can easily get to a state of paralysis by analysis in our decision making.

Long ago and far away we thought of PCa progression as linear and sequential, first one prostate bed, then to the lymph nodes, higher and higher, wider and wider to bones and organs. Think of a nuclear blast...do a literature search on circulating tumor cells in PCa, enlightening...

Not so much anymore. I think today we generally understand PCa can spread in a haphazard way, hitching rides though our lymph node system, veins....it may not stop at the first available location, rather continue in our circulatory system and stop somewhere, where and why, nobody can say with any degree of certainty.

If you want to try for the gold standard, the elusive cure, by all means, do it. If you do, don't tread lightly, go full Monty, SRT to the prostate bed, include Whole PLN and add short term ADT. You don't want my experience when I did SRT to the prostate bed only, then have my radiologist turn to me 90 days after finishing the SRT and say, "Kevin, you'r PSA is now .7, more than doubled, the SRT failed, there is likely PCa in your lymph nodes!" There was...

Keep in mind I had let them talk me out of including the WPLN and six months of ADT because "we don't have long term data on that...!"

Also keep in mind the difference between our cancers, I am high risk, you are low. Mine dictates aggressiveness, yours may indicate a take it slow approach.

If you go for the cure and if you elect to go full Monty after discussing with your medical team, question is what are the side effects. As I've said, from radiation, I have experienced none. Six months of ADT, well, you may experience the inside effects but recovery in short term use of ADT is generally favorable.

Your very kind. Thank you. I think I'm going full boat. I will keep you posted. Thanks again.

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