1st PSA test seven weeks after surgery

Any 2nd level drug will do. Darolutamide has fewer side effects.

The advantage of taking abiraterone is, if you get a couple of years of that drug, you can then move to Darolutamide and get three or four more years, That’s what I did. I can’t say how long Darolutamide or any other ARSI Will work. Changing them may get a longer progression free survival, I think, it works for me.

I agree about fighting hard and early. The thing is, you have no detectable metastases at this point (if I read the thread correctly), so your cancer is likely localised and very early stage.

The slightly-elevated PSA shows that something's going on, but it would surprise me at this point if they were to approve more-extreme treatments like chemotherapy (Docetaxel); they don't even typically use that even for stage 4b oligometastatic, at least not until the cancer becomes castrate-resistant and/or polymetastatic.

As others have suggested, unless they find anything new on imaging, ADT to slow/stop any progression, then (after you've had time to heal from the surgery) salvage radiation to the area around where the prostate used to be seems most likely. If your cancer is still non-metastatic castrate-sensitive (nmCSPC), I'm not sure if any ARSIs are approved for you yet: I *think* the cancer needs to be either metastatic or castrate-resistant before you can use Abireraterone or one of the -lutamides.

Best of luck with your next treatment steps!

7 weeks is a short time for an initial PSA test following prostatectomy. There still may be remnants of PSA still in your bloodstream - which is why they usually wait until around 3 months.

Certainly can understand your apprehension about waiting. But, you also don’t want to have unnecessary treatment.

Perhaps consider having PSA tests every couple of weeks to see if the PSA is continuing a downward trend? That would help decide what to do next.

Wouldn't be surprised to see Orgovyx with a lutamide, either daro or apa. Should bring PSA right down and progression-free survival is very good. Darolutamide apparently has fewer side effects.

Recently abiraterone (Zytiga) has been approved for hormone sensitive PC. I do not know what other criteria
are required to consider its us. Eventually systemic radioligands ( PLUVICTO [PSMA-Lutetium-177] ) will be added to the hormone sensitive too,

To: @thmssllvn

Zytiga has been used for hormone sensitive patients for a long time, Probably from its inception. I was on it for 2 1/2 years when I was hormone sensitive (starting 2017). That is the first drug they give to people whose ADT starts to rise after treatment, Or even before treatment If aggressive. I became castrate resistant while on Zytiga. You can’t do that unless you start off castrate sensitive.

Not sure where you saw that it was just approved for hormone sensitive, but that is just not correct.

John Davis 60:

Yes it upsetting.

My 1st PSA post RP at Johns Hopkins was taken at 30 days and persistent at .19

Gleason 9 with EPE from Post-Op pathology.

So I was very disappointed with the pathology report and not stunned, but terribly disappointed, at the first PSA result.

My RO at Johns Hopkins prescribed Salvage Radiation to the whole pelvic region (WPRT) including the pelvic lymph nodes, together with ADT, and I chose Orgovyx.

I also had a PSMA Pet scan which did not reveal any specific tumors or areas of definite metastasis.

My radiation was IMRT 66.6 GY to the prostate region (45 GY to the pelvic lymph nodes), delivered in 37 txs of 1.8 GY each.

Tested 6 mos after radiation completed and PSA has been undetectable at < .02 for last 18 mos of testing.

Having surgery at 72 and then immediately having Salvage Treatment was a lot, however I am now 75 and feeling well.

So I empathize with you and wish you the best. And I hope and believe that your additional treatment will be successful.

Thank you @michaelcharles ! i believe the RO’s plan is to radiate me over 37 sessions.
I also had a PSMA pet scan prior to surgery and they found no spread so hopefully the radiation and other treatments will keep me alive until 60 ( I’m 50 now). Thanks again:)

Yes Zytiga (abireterone) was approved in 2018 for hormone sensitive pts.

The OP seems to have non-metastatic castrate-sensitive prostate cancer (nmCSPC). I can't find anywhere that says Abiraterone (Zytiga) is approved for that, but I may have missed something.

As @jeffmarc and @thmssllvn wrote, Abiraterone has been approved for metastatic castrate-sensitive prostate cancer (mCSPC) for quite a few years. Apalutamide (Erleada), Enzalutamide (Xtandi), and Darolutamide (Nubeqa) are also approved for mCSPC.