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Salvage radiation decision: with or without hormone therapy?

Posted by chuckbies @chuckbies, Jun 10 1:03pm

I had a prostatectomy in 2021. PSA was undetectable for 2 years. Then PSA went to 0.1 in 2023, and then 0.2 in 2024. I saw an Oncologist last month who recommends salvage radiation to the prostate bed. I will do that soon, but first need to make a decision on whether I should do hormone therapy with the radiation therapy. I have a family history of prostate cancer, and my PSA was fairly low (5.0) when I had the initial biopsy and diagnosis, which showed prostate cancer existed in all samples. The Gleason score was the bad 7. I had a PET scan and bone scan before surgery which did not show any signs of metastatic prostate cancer. So my question to the group is: should I do hormone therapy at this time? Or just do radiation and see if that works? I'm 64 and in good health.

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dpayton | @dpayton | 21 hours ago
In reply to @ga73ds "I was Gleason 9 and a very high Decipher as well. All signs that the cancer..." + (show)
@ga73ds

I was Gleason 9 and a very high Decipher as well. All signs that the cancer was aggressive. Had surgery- removed prostate, seminal vesticles, and 7 lymph nodes. 1 node was positive. There was some positive margin after surgery. I had followup pelvic radiation and have been on ADT (Orgovyx) for 2 1/2 years. My PSA has been < 0.01 since (for 2 years).

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That is AWESOME news!!! Love the PSA. I've had a very similar path. My Gleason was 8-9. Had surgery to remove the prostate. All 11 lymph nodes clear. First PSA was .2 so so obviously some cells still there. PSA then rose to .8 after 6 months so radiation and ADT was the plan of attack. Eight months after, my PSA is at .01.

My question, was does the a positive lymph node mean going forward? Really new here. Thanks everyone!!!

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chuckbies | @chuckbies | 10 hours ago
In reply to @jaacm1 "I was in a very similar situation as you except I had a 3+4/ 7 Gleason..." + (show)
@jaacm1

I was in a very similar situation as you except I had a 3+4/ 7 Gleason with a family history of prostate cancer. A PSMA test showed no spread. When my PSA got to 4.5, I had RP. I had a positive margin. My PSA after surgery started at .02 and slowly crept up to .17. Some folks consider "undetectable" as any PSA score less than .1. I don't - to me any score no matter how low is detectable. That said my PSADT was less than a year so I chose (after securing multiple opinions) to take 6 months of Orgovyx and RT to the prostate bed and lymph nodes at approximately one year after my RP. I am now undetectable (< .006) and hoping it continues to stay at this level for a long time. I do have some manageable incontinence and ED issues. I'm grateful for the early success and comforted that I chose the aggressive path I did. Good luck. There is no looking back.

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@jaacm1 You mentioned you have manageable incontinence and ED. I also have these issues following RP surgery and I never fully recovered. As I'm considering ADT, I've read that it could have significant side effects regarding incontinence and ED. Was your incontinence and ED a result of your RP surgery, or did it happen after starting Orgovyx? If it was a result of RP, did it get worse after starting Orgovyx?

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jaacm1 | @jaacm1 | 2 hours ago
In reply to @chuckbies "@jaacm1 You mentioned you have manageable incontinence and ED. I also have these issues following RP..." + (show)
@chuckbies

@jaacm1 You mentioned you have manageable incontinence and ED. I also have these issues following RP surgery and I never fully recovered. As I'm considering ADT, I've read that it could have significant side effects regarding incontinence and ED. Was your incontinence and ED a result of your RP surgery, or did it happen after starting Orgovyx? If it was a result of RP, did it get worse after starting Orgovyx?

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Chuck, I was able to overcome my incontinence after RP by doing kegels. Regarding ED, I was ok (needed a prescription) after RP but not 100% the same as I was heading into the procedure. Orgovyx worked well on me and lowered my T from over 600 to almost nothing. For the 6 months I was on the drug it eliminated all interest/ desire. When I came off the Orgovyx and had gone through SRT, the desire returned but I still need a pill. That said, the combo of the hormone and the SRT definitely negatively impacted me as compared to where I was pre-RP and post RP. My T is over 500 last time it was checked.

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