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Salvage radiation decision: with or without hormone therapy?
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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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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2 Reactions@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?
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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1 ReactionADT 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.
Jeff - thanks for all the information you have been providing on the questions I've been asking. You are very knowledgeable about the current research and treatment options. After reading the messages from you and others, it seems like ADT slows down cancer growth, but doesn't kill the cancer cells. And the only way to actually kill the cancer cells is through surgery or radiation. Also the cancer cells can mutate to make them ADT resistant. So it seems there is a high probability after ADT treatment that the cancer will eventually come back, and could become castration resistant.
I'm 64 and currently have a PSA of 0.2 after 4 years post RP, PSADT of 1 year, post RP clean margins and lymph nodes, and a negative PSMA/PET scan. I didn't have a decipher test done at the time of RP surgery. In a Dr. Kwon video, his recommendation was to wait until a scan positively identifies the cancer spot and then kill it with radiation. I'm hoping to get into Mayo soon to have a Choline 11 scan done. If that is also negative, does the current body of research support waiting until a scan identifies the cancer? Are there stats showing the effectiveness of waiting to identify the cancer and using radiation to kill it? For example, after this treatment plan, how many patients have their PSA increase again and have additional radiation treatments?
I believe I saw a statistic that salvage radiation to the prostate bed is about 30% effective at killing all remaining cancer cells with a PSA around 0.2 - is that correct? Are there stats showing how much more effective adding the ADT therapy on top of the radiation is?
Lots to consider and I appreciate your help and everyone else who is contributing to this forum! I will continue to share my treatment plan and effectiveness as well. A Huge Thank You To Everyone!!