@lyricw

When my surgeon reviewed the pathology report with me after surgery in March 2014, he said I should not have any problems in the future.

I'm thinking "Mx," they don't know if it has metastasized....!

I plugged the numbers in to MSKCC nomogram and it said 30% chance of BCR.

That's a 70% chance of not...

15 months later...

Would having elected to do adjuvant salvage radiation therapy to the prostate bed after surgery have changed the outcome? We'll never know. The pathology report didn't support it.

I'm also surmising that my PCa was already in the lymph nodes, that it was nit localized. So, anything that just radiated the prostate bed was doomed to failure.

When we did SRT starting in March 2016, the standard of care was to radiate the prostate bed only. There was data emerging from clinical trials as well as what Mayo had been collecting on BCR in high risk patients, that the pelvic lymph nodes were already involved and they needed to be included in the radiation treatment plan as well as short term systemic therapy, six months.

I inquired about that, my medical team pushed back, no long term data to support. I acquiesced, SRT was an epic failure. Again, would the addition of radiation to the pelvic lymph nodes and six months systemic therapy have "cured" me? We'll never know.

In 2023 when my OSA started rising, a PSMA scan showed a single lymph node active. Data was emerging that MDT by itself may push back the need for systemic therapy in that situation. We opted to add 12 months systemic therapy knowing there was more than the PSMA scan could see.