Salvage radiation decision: with or without hormone therapy?

My PSA after SRT (Prostate bed and lymph nodes) was detectable at 0.014 (Roche ultra sensitive test) when taken at 3 months after my last radiation treatment. My PSA went undetectable at 6 months after last SRT treatment to < 0.014 (Quest test). At nine months PSA (Roche test) went to < 0.006 and has stayed there. So don't be too discouraged should you not get to undetectable at your first test. My experience was as mentioned - it takes time for the radiation to do its job. Good luck.

Thanks. Very helpful. MSKCC uses a tolerance limit of < .05 to be considered undetectable so yours would have been considered undectable. Even if mine is ' undetectable' next week , I won't really know if was the radiation that did that or thr Orgovyx, ( since ADT does not directly kill cancer cells). The reason I say this because a guy I ran into at the radiation unit said his PSA was undetectable after a Lupron shot , but before he even started radiation.

You are Right, The Orgovyx did it, In the library, when the lights were out. Now Back to reality. Your testosterone and PSA have no chance if you’re taking Orgovyx, They are going down. You will not know the results of radiation until you stop.

As @jaacm1 says, it took 6 months to really Drop to a low. In some cases, it can take up to three years for people’s PSA to drop to the bottom after radiation has finally killed off all the cells.

Since you are on Orgovyx You don’t have to worry about the possible slow drop of your PSA as radiation kills off the cancer cells since yours will drop quickly.

That MSK indicator really bummed me out when I saw my first result. I thought “All this radiation and ADT to go from .18 to .05??!”
But my RO assured me that this number was their lowest possible score…felt MUCH better after that!
My PSA was undetectable after 1 month on Orgovyx so that really does the trick numbers-wise. It’s the radiation/ADT combo that gives the sustained killing effects months down the road.
Phil

So the last radiation was today. Got my PSA tested yesterday and it was undetectable. But as you say- there's no way to know for sure if that's the Orgovyx or the radiation. I'm in the same boat as you just a few months behind. We both have a very high probability of having it be successful.

It's a toss up.
When I had my salvage radiation therapy, my radio oncologist thought it wasn't needed. He's a world expert and I think his reasoning was given my low PSA and negative Axumin exray, the cancer was most likely confined to the pelvis bed. It turned out that in fact a bit had slipped out further to other lymph nodes. PSMA PET was not widely available in 2017 not even at Georgetown Medstar. If it had been he'd have used it and seen the lesions outside the bed and zapped them too. As it was, he was right for the lesions in the bed. Subsequent PSMA at Sloan Kettering Clinical trial showed he'd nailed all the lesions in the fossa bed. My guess is your guy with the benefit of "all seeing PSMA" now sees lesions only in the bed and thinks he can eradicate them with radiation alone. There is a theory that ADT or an ARSi like Enzalutimide could help by radiosensitizing the cancer. He may not think it's necessary in your case. Bear in mind with PSMA now- they can spot very small deposists of the cancer. I'd talk it over with your doc.

I think your doc is just following SOP here. In your case, he's probably reasoning that in all likelihood the recurrence is in the prostate bed - its likely spot. I'm assuming your pathology report after prostatectomy showed N0 for the couple lymph nodes the took out and microscoped. Guessing your doc based on experience w hundreds if your cases that he can try radiation alone and see what develops.
But there is literature out there about the efficacy using ADT in salvage radiation but I'm not sure it addresses cases w negative PSMA. You might check it out and then talk to your doc.

One last thought
Your doc may be holding off ADT to see if the recurrence is in fact confined to the likely fossa bed. If he uses ADT that will affect all the lesions including ones outside the bed
If he doesn't use it, zaps only the bed, and PSA goes to zero, he'll know there aren't any lesions outside it- otherwise they'd still be putting out PSA

That’s a great point and my oncologist is thinking that way too. I’m going to Mayo for a second opinion soon. Thanks for your feedback!

There's debate among the docs on this. I but on balance it seems the majority come down on us