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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 | 1 day 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 | 14 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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2 replies
jaacm1 | @jaacm1 | 7 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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jeff Marchi | @jeffmarc | 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?

Jump to this post

ADT reduces testosterone levels, and androgens play a role in maintaining the strength of pelvic floor muscles. When these muscles weaken due to ADT, it can lead to urinary incontinence.

The ED problems occur after surgery, The ADT drugs take away the desire, Which can’t affect the ability to get an erection, But the real problem is that many men after RP just can’t get it up without assistance from drugs or a pump.

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