Should I add ADT to Salvage Radiation at age 76?

@jeffmarc

Yes, you remembered well Jeff : ).
And yes, my husband will need ADT at least for 6 mos (we were told), regardless of how low PSA is. Even if we decided to have adjuvant immediately post op with uPSA undetectable, my husband was advised to have ADT since he is a high risk patient.

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/

@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/

@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/

@wwsmith
It seems the complete Post is actually here
https://www.urotoday.com/video-lectures/asco-gu-2026/video/5413-poseidon-meta-analysis-re-examines-the-role-of-adt-with-salvage-radiation-for-prostate-cancer-amar-kishan.html
In this particular case, the PSA went from .3 to .7 in 18 months. That’s not a very fast, doubling rate. The article does say ADT over .5 for a short term does make sense. I know in my case I only had .2 and I got A six month ADT shot. I didn’t even notice the side effects back then, But it reoccurred in 2 1/2 years And I had to go back on ADT full-time.

When the doubling rate is so slow, they might even consider not doing the ADT. I would let a doctor make that decision.

Interesting article though.

@jeffmarc Yes, a full discussion of the POSEIDON trial is at the link you gave. But what I was trying to emphasize was that the article does not mention that high Gleason and Decipher scores should also be considered on the decision about whether ADT is needed or not with salvage radiation. And yet, when a former patient of Dr. Kishan with high Gleason scores and a high Decipher score contacts Dr. Kishan about whether ADT is needed for his case even when his current PSA is less than 0.5, Dr. Kishan readily advises this patient that high Gleason and Decipher scores should always be factored in on whether ADT is needed or not for salvage radiation. Sure wish the recommendation on consideration of high Gleason and Decipher scores was actually mentioned in the POSEIDON article.

@jeffmarc Yes, a full discussion of the POSEIDON trial is at the link you gave. But what I was trying to emphasize was that the article does not mention that high Gleason and Decipher scores should also be considered on the decision about whether ADT is needed or not with salvage radiation. And yet, when a former patient of Dr. Kishan with high Gleason scores and a high Decipher score contacts Dr. Kishan about whether ADT is needed for his case even when his current PSA is less than 0.5, Dr. Kishan readily advises this patient that high Gleason and Decipher scores should always be factored in on whether ADT is needed or not for salvage radiation. Sure wish the recommendation on consideration of high Gleason and Decipher scores was actually mentioned in the POSEIDON article.