When I was 51 years old, my PSA peaked at 2.0 right before surgery (Dec-17). I was Gleason 4+3=7. In early 2019, I had the prostate bed radiated with 2 years of ADT (PSA was under .2 when I started ADT). Then in early 2023, my PSA rose to about 1.5 within 6 months before radiating a lymph node region. I am about to start triple therapy treatment due a reoccurrence on the hip bone, along with a few smaller potential legions growing in size when PET scans are compared over the past few years. My PSA hit .25 this year before I went back on ADT. One of the reasons for the triple therapy is because I have had low PSA scores, so my oncologist believes these smaller lesions are going to be a bigger problem than my PSA score suggests. She also thinks that based on my age (58) that we should hit it hard for the best long-term outcome.

Mayo tells me 10-20% of advanced cases are in men with no or low PSA. Separately, I was told by Mayo to start ADT at least 30 days before radiation with 18 months being the longest needed duration (when radiating the prostate bed and the lymph node region). When I was contemplating hip radiation, Mayo was going to put me on ADT for 4 months (start ADT 30 or more days before radiation, which was going to be done in a single session). But anytime I talk to anyone about radiation, so ADT has been included.