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Should I add ADT to Salvage Radiation at age 76?

Prostate Cancer | Last Active: Mar 26 6:43pm | Replies (30)

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Profile picture for Jeff Marchi @jeffmarc

One problem is that you’ve waited a little too long before doing radiation. As a result, the American Society of clinical oncology (ASCO) recommends that you have ADT. You could Put it off until you come back from your trip. It may allow the cancer to grow a little bit, But it is an option. One thing is you do not have a higher risk case since you are a 3+4.

When I have my first ADT shot after my cancer came back, following a prostatectomy, I didn’t even notice the side effects And two months later, I had Eight weeks of salvage radiation. It was a six month shot. 2 1/2 years later when I had to go on ADT full-time then I noticed the side effects.

I’m 78 and I’ve been on it for eight years. I have no fatigue at all nothing that would prevent me from really getting out there and doing whatever I want. I walk a mile at high speed twice a day and I go to the gym three days a week to get weight exercises.

Check out the recommendations from ASCO

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/

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Replies to "One problem is that you’ve waited a little too long before doing radiation. As a result,..."

@jeffmarc Looking at the ASCO recommendations, it appears that the need for ADT with salvage radiation is driven primarily from PSA levels at the time of treatment. Whereas the need for ADT with radiation as a primary treatment is affected by numerous factors like Gleason score, Decipher score, intraductal, cribriform, seminal vesicle invasion, EPE or ECE (extraprostatic extensions or extra capsular extensions). The ASCO approach seems a bit simplistic to me to look only at the PSA level of a salvage radiation patient because if such a patient with many previous risk factors (high Gleason, high Decipher, intraductal, etc.) decides early to get salvage radiation treatment while with a low PSA value, ADT would automatically not be prescribed even though it might well be beneficial.

@jeffmarc Just saw a post on the Inspire forum where a patient with Gleason 4+5 and Decipher 0.98 consulted with Dr. Kishan who was involved in the POSEIDON study the ASCO recommendations about ADT were based on. Dr. Kishan noted that the POSEIDON study pertained to a general post-surgery population (i.e., all Gleason scores), whereas high Gleason scores are important in the decision making for the use of ADT. Also, for that study, men's Decipher scores were unknown and/or not used although high Decipher scores should be considered as well on the need for ADT with salvage radiation. See the complete post here,
https://www.inspire.com/groups/zero-prostate-cancer/discussion/bda128-adt-and-salvage-radiation-after-surgery/