Salvage Radiation Therapy with or without ADT added?

@bikeman1
Hey Bikeman 🙂 - did you start your therapy ? I hope that you have zero SA from ADT and apalutamide 🍀

Thanks for sharing the name of that study, I will check it up ASAP !

How many Gys will you get and in how many sessions ?

Thanks so much in advance 💗

@surftohealth88
I had intended to keep this thread up to date but there have been...complications. First, the recommended ADT (Orgovyx) is contra-indicated with my heart medicine (Flecanide); we are sorting that out with my cardiologist. Second, the MRI showed two potentially involved pelvic lymph nodes; we are waiting on PET scan results (6/2) before proceeding.
Here is what my RO recommended BEFORE the MRI was done (and other test results confirmed aggressive cancer): IMRT and IGRT to treat to approximately 66-70 Gy to the prostate bed. Treat nodes to 45 Gy.
Any reactions to those recommendations?

@bikeman1
These are pretty standard recommendations when reoccurrence happens. 3 1/2 years after my prostatectomy, my PSA started rising, and I had 40 sessions of IMRT. They didn’t have IGRT 12 years ago or I would asked for that.

You also want the pelvic lymph nodes radiated. Pretty standard procedure.

Hopefully this will get your PSA down to undetectable for a while, and you won’t need ADT. Of course your doctor will Probably want you on it because of the aggressiveness of your diagnosis. See if you can use Darolutamide, One of the other glutamine instead. Enzalutamide Has been approved for use without ADT.

Another option might be estradiol patches, Which work as well as ADT but worked totally differently on the body. Not sure if your doctor is really up on them, Many will not approve.

@surftohealth88
I had intended to keep this thread up to date but there have been...complications. First, the recommended ADT (Orgovyx) is contra-indicated with my heart medicine (Flecanide); we are sorting that out with my cardiologist. Second, the MRI showed two potentially involved pelvic lymph nodes; we are waiting on PET scan results (6/2) before proceeding.
Here is what my RO recommended BEFORE the MRI was done (and other test results confirmed aggressive cancer): IMRT and IGRT to treat to approximately 66-70 Gy to the prostate bed. Treat nodes to 45 Gy.
Any reactions to those recommendations?

@michaelcharles
Thank you for your detailed clinical history. It seems like my case is similar to yours. I hope that I turn out as well as you have, regardless of whether I end up with ADT or not, which will be decided later this week with my Oncologist.
Much appreciated!

@bikeman1
I know - everything has to be so complicated :(((. Just as one thinks that all is finally lined up, something has to happen to make it more challenging.

I am so sorry that your heart medication is not compatible with Orgovyx, what a bummer !!! I really hope that your PC team and your cardiologist will come up with good solution very soon. 🍀 I also hope that PSMA will show zero node positivity, but if they are positive, than they will perhaps add longer ADT use or add some Nubeqa to it.

Our RO also suggested 66 Gys total to the whole pelvic floor and nodes + 6 mos of Orgovyx. This is also preliminary plan - we are waiting for PSMA results (he had a scan Thursday) and MRI is to be scheduled. My husband started Orgovyx yesterday. We will know how he reacts to ADT in about 2 weeks when SA usually start to happen. Hopefully they will be tolerable *knock the wood 🧿.

All in all, we are also still going through testing and scanning phase 😞, still a lot of unknowns. The only comfort is that my hubby started with ADT.

Wishing you all the best and completely clean PSMA scan 🍀 ! Nodes sometimes get enlarged due to different things and perhaps it is just some inflammation going on which is very often the case.

@animate
I was in a similar position to you except my PSA stayed <.02 for 2 years after my prostatectomy. My pathology showed Gleason 7 3,4 with 4 being 30%. My tumor volume was 30%, had cribform and EPE and pt3a. My lymph nodes were good but to areas were questionable and Sloane said it went to the bladder neck.
When my PSA started up and it got to .18 I was told I would need SRT. They sent out a sample out at this time for a decipher test and it came back at .92. With it being that high they told me I needed 6 months of ADT also. I got the second opinion from Sloane Kettering and they recommended the same. The only difference was Sloane uses SBRT for 5 Sessions versus URMC uses IMRT for 38 sessions. I currently have been on ADT for 5 month’s Orgovyx and have completed 20 sessions. I am currently 72 years old and am doing radiation hoping for a cure. I do not like being on Orgovyx, it affects me emotionally and mentally. I am tired and it makes me weaker. There is no question that physical activity helps, it takes away the tiredness but my legs give out when skiing longer runs, there are days I get on my elliptical and I get a hot flash overheating and my legs are dead. Other days I am ok doing my 30 minutes. I was working out and doing 3 mile walks prior, I have learned to do more frequent walks with less length. The mental part is a little better as I am on drugs to help it. I am glad I will be getting through the ADT and can get back to the way I was.
You should get a decipher test so you have more data available to you.
Because I have hypersensitivity in the pelvic area I was told that adt may be the better option for me getting “vacations at times” or I could wait and see the PSA go higher. I chose radiation because I want a cure even though it could trigger extreme pain which they are using drugs to control. After being on adt which changes me as a person I am glad I went this way. And if adt in any way might help me cure it, I would do adt for the six months. I am counting the days to June 18 when I finish adt and radiation. The radiation has only caused me diarrhea so far which is a minor issue to date.
Wishing you the best and happiness always.

@pamperme
Thanks for the details on what your treatment experience has been like; I hope you get through the rest of the treatment regime as well
as possible and without any additional complications.
Our cases are also very similar, except I beat you on the new Decipher score on the full prostate : .96 (was .89 on from the biopsy).
I was always an overachiever! (sorry, bad attempt at humor). Good luck to you.

@animate
I was in a similar position to you except my PSA stayed <.02 for 2 years after my prostatectomy. My pathology showed Gleason 7 3,4 with 4 being 30%. My tumor volume was 30%, had cribform and EPE and pt3a. My lymph nodes were good but to areas were questionable and Sloane said it went to the bladder neck.
When my PSA started up and it got to .18 I was told I would need SRT. They sent out a sample out at this time for a decipher test and it came back at .92. With it being that high they told me I needed 6 months of ADT also. I got the second opinion from Sloane Kettering and they recommended the same. The only difference was Sloane uses SBRT for 5 Sessions versus URMC uses IMRT for 38 sessions. I currently have been on ADT for 5 month’s Orgovyx and have completed 20 sessions. I am currently 72 years old and am doing radiation hoping for a cure. I do not like being on Orgovyx, it affects me emotionally and mentally. I am tired and it makes me weaker. There is no question that physical activity helps, it takes away the tiredness but my legs give out when skiing longer runs, there are days I get on my elliptical and I get a hot flash overheating and my legs are dead. Other days I am ok doing my 30 minutes. I was working out and doing 3 mile walks prior, I have learned to do more frequent walks with less length. The mental part is a little better as I am on drugs to help it. I am glad I will be getting through the ADT and can get back to the way I was.
You should get a decipher test so you have more data available to you.
Because I have hypersensitivity in the pelvic area I was told that adt may be the better option for me getting “vacations at times” or I could wait and see the PSA go higher. I chose radiation because I want a cure even though it could trigger extreme pain which they are using drugs to control. After being on adt which changes me as a person I am glad I went this way. And if adt in any way might help me cure it, I would do adt for the six months. I am counting the days to June 18 when I finish adt and radiation. The radiation has only caused me diarrhea so far which is a minor issue to date.
Wishing you the best and happiness always.

@bikeman1

Well, sorry to rain on your parade dear Bikeman !!!
I have to inform you that my husband still holds Decipher record here 😝 - it is solid 1 in BOTH samples - biopsy Decipher AND post op whole gland Decipher ! So ... you need to work on that prostate some more young man !!!🤪 lol

I know, what person to do but sometimes laugh at insanity of this condition *sigh When I saw that "1 " for the first time I cried so much that my husband teased me that I would feel better if it was 89 (??) and I said "PRECISELY !!!" I would feel better 😔 ! I know that it sounds insane but having the worst of everything possible in this pathology is just like somebody "up there" is making a very cruel joke with me and is rubbing salt in open would constantly.

Oh well ... " Per aspera ad astra" , as old Romans used to say - hey, no hero or saint had it easy - right ??? lol 😉