Continued hormone therapy? or not?

@lacraig1
I think I answered this in another message but if your PSA hits .2 the recommendation is that you get salvage radiation. ADT is quite often Used just before the radiation to try to shrink the tumors.

Since your PSA is so low, you can’t have a PSMA PET scan which would tell me whether or not you have had the cancer spread somewhere else in your body. The ADT may have stopped that, but they have found that even on ADT with an undetectable PSA you can get metastasis. I was on Zytiga for 2 1/2 years and my PSA stayed very low, but not undetectable, I got a metastasis on my spine and had it zapped. That was found out when I stopped 1 zytiga pill (out of 4) For 18 days and my PSA went from .2 to 1, So then the PET scan was now possible, and it found a metastasis.

Here’s what the standards are for getting salvaged radiation after a prostatectomy.

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

thank you
my mind glazes over when I read all this
I have had my one doctor for 8 years now. (lymphoma before) I often call him the smartest doctor I know.

I'm on ADT and radiation starts tomorrow

thanks again

@lacraig1 Christmas Eve, I complete one year of ADT (Orgovyx) and had 44 radiation treatments last spring. No surgery. Three lesions in prostate, two questionable spots in adjacent lymph nodes, so the recommendation is for 18-24 total months on ADT. My wife and I have begun to accept that, even at my age (74), prostate cancer is a disease to be managed rather than to expect a complete cure. We live in Texas, the land of Yellow Jacket wasps. When I spray a nest, one or two are too quick for me and I'll find a new nest being built a couple of days later. Prostate cancer seems to act like this: if even one cancer cell escapes treatment, it can multiply at any point later. The good news is that it's almost always treatable, regardless recurrence, as @jeffm has commented about his experience. A fellow support group member commented last night that his first diagnosis and treatment were in 2009, and he's currently on treatment. And new treatments are continually being developed.

thank you

I'd discuss it with both your Docs.
There's an increasing recognition that ADT isn't an unbridled good carrying with it not just hot flashes, erectile libido issues, and potential heart issues.
A lot turns on the relative aggressiveness of your cancer, usually determined by its doubling time. It could be the Doc suggesting it has some concerns here and is suggesting it as an intermittent measure. The field is pretty well alerted to this now so you should get good discussions from both.
Also suggest Google AI the issue. You punch in your data and pop the question. It could save your Docs a lot of time.
Good luck!!

@lacraig1 I don’t think that ADT cures cancer, but rather inhibits cancer cells from growing and spreading. If you don’t have any prostate cells left, ADT is unnecessary. Unfortunately, prostate cancer cells can be microscopic and not detectable until they grow. I don’t think you know until the cancer either returns or it doesn’t. ADT can slow the process and can provide 20+ years of survival. I do intermittent ADT and not continuous ADT because I found the side effects awful and was on ADT for three years with “undetectable” PSA. I have now completed 15 months off ADT now with no detectable PSA. If my PSA becomes detectable, I will start ADT again and hopefully have a PSMA PET scan that can pinpoint the area that requires radiation. Bottom line, none of us know what will happen and we are all going to die at some point, so the most important thing is to maximize quality of life right now and practice gratitude. Really enjoy each moment. Right now. What are you waiting for?

wise thoughts? thanks for sharing.