Chuck, I completed 38 fractions of salvage IMRT on November 18 (no ADT). Hit the prostate bed as well as the pelvic lymph nodes, prophylactically. First follow up PSA will be in mid February 2026.

I had a RARP in 2015. Gleason 3+4, one positive margin, Prolaris score 1.7 with a 53% chance on BCR at ten years.

I went ten years with undetectable (< 0.1) PSA. Then in June 2025 my PSA hit 0.11 (Quest). A repeat test a few days later yielded the same result, ruling out lab error. Then, a DRE detected a palpable nodule in the prostate bed. That precipitated a PSMA PET scan and MRI with contrast, both confirming that the nodule was cancerous. No scanning evidence for pelvic lymph node involvement, nor distant mets.

Two oncologists recommended short-term ADT with the IMRT, one did not. I weighed the pros and cons for my case. The barely detectable PSA and ten years to recurrence were strongly in my favor. Three months after my PSA hit 0.11, it remained unchanged, and actually an usPSA test from Labcorp yielded 0.094. Curious to think that if I had that test back in June, I likely would have been told to come back in a year, rather than getting scanned and diagnosed with recurrent PCa.

Anyway, I decided against the ADT, concluding that the benefits did not outweigh the risks for me. Gray area decision. Someone else with different concerns/priorities may taken a different path.

Another oddity of my case was that despite the low PSA, the nodule lit up on the PSMA PET scan with a max SUV of 13.3. Data don’t always align, and sometimes they defy conventional wisdom, but I think the important result was that the nodule lit up and nothing else did. My urologist concurred.

I posted a long summary of my IMRT experience if you haven’t seen it: https://connect.mayoclinic.org/interaction/discussion/68361/reactions/listview/

I will add that post-RT, I have had a bunch of rashes and skin irritations in different parts of my body. Bothersome and unsightly, but my dermatologist saw nothing serious. Probably opportunistic fungal or viral flare ups because my immune system was whacked out. They seem to be resolving now. I didn’t think that my RT fatigue was real bad, but now in late December, I am feeling pretty much back to normal energy levels (am 73 now). Looking back, I was more wiped out by the RT than I realized. Getting back to full energy capacity took more than a couple weeks. Feels good to just be living a normal life again, including not being on the “full bladder/empty rectum” diet.

Hope your RT goes well.

Here’s to a better 2026 with ultra low PSA! I’m sure we will be comparing and sharing PSA scores and progress in the new year.

Mel