after 25 years from radical prostectomy, psa values have increased

Ask to have nubeqa instead of ADT. It has almost no side effects and will keep your PSA low. I know a lot of elderly people that are on it and love it.
When I had eight weeks of IMRT radiation I had no side effects at all. Because you will have fewer sessions you may have some issues with peeing it can burn, but it goes away after a couple months. If that does happen, come back and ask, there’s a drug you can take.

Sorry to hear that, doesn't this prostate cancer ever go away. After 25 years, I would have thought no way it would come back. I am learning a lot and seems this stuff can hide for a long time.
I certainly would do some checking on options at multiple locations.
Lots of folks on here have knowledge about things like this, not me, I am learning.

It all depends on your general health. Well Controlled HBP or diabetes usually remains stable with ADT.
But I would opt for 6 months Orgovyx (fewer SE’s than Lupron) along with IMRT if you do choose to have treatment.
It’s the combo of ADT/radiation that causes the cancer to die; studies are finding that for localized recurrence, longer than 6 months is of little benefit and can actually be harmful.
Best,
Phil

The PER test indicate activity both in the prostatic loge and in the linphonodes in the pelvic region . They provisionally indicate ADT for two years or only IMRT for time length to be decided. Should I avoid ADT altogether?

I had a local recurrence last year, ten years after a prostatectomy (age 72 at time of recurrence). I did 38 sessions of IMRT without ADT. My PSA going into radiation was 0.1 and six months later it is still 0.1. My recurrence was first detected as a small nodule in my prostate bed, and a PSMA PET scan showed the nodule to be highly active.

Some thoughts regarding your situation:

- before considering ADT, get your testosterone tested. Testosterone tends to drop with age.

- if you do IMRT, hit the pelvic lymph nodes as well as the prostate bed. Research studies have shown that this yields better outcomes.

- IMRT alone can cause pronounced fatigue (resolves a few weeks after therapy). Adding ADT can turn that into extreme fatigue. Vigorous exercise can help with the ADT induced fatigue. I don’t know what your physical condition is, but I would have a serious conversation with your docs about the impact on your quality of life from the treatments. On the flip side, the side effects of ADT often diminish with age, mostly because testoterone is lower. Only you can decide if it either of the therapies are worth it or not.

- oncologists especially can get focused on curing disease over treating patients. If you have a trusted PCP, perhaps have a frank and open discussion conversation with him/her about your treatment options and quality of life. They tend to have a more patient centered view.

- get a second opinion. I actually got opinions from three oncologists before initiating radiation therapy.

- folks often focus on the immediate side effects of ADT like hot flashes, fatty weight gain, breast enlargement, penis shrinkage, etc. But there are also metabolic side effects such as increased risk of cardiovascular disease (including death from stroke and/or heart attack) and cognitive decline. Gather information on these risks relative to your health and medical conditions before finalizing any decisions. Many folks here are as knowledgeable as your docs, and often are more forthcoming.

- not all hormone therapies (ADT and ARPI drugs) are created equal in terms of side effects. As Jeff noted, Nubeqa (darolutamide, ARPI in pill form) is often well tolerated. In contrast, Lupron (leuprolide, ADT given as an injection) often has some brutal side effects. Learn everything you can about hormone therapies before agreeing to any doctor’s recommendation. Again, the brain trust in this group can really help you with that.

- radiation therapy will require “full bladder and empty rectum” to be most effective and to mitigate radiating healthy tissues. This can be achieved by proper dietary adjustments but it can be a daily stressor during treatment as well. Best to make necessary dietary adjustments at least a couple weeks before initiating radiation therapy. As with hormone therapy, get well informed about what to expect before starting treatment.

- the fact that 25 years have passed until your PSA rose above detection is in your favor (suggests non-aggressive cancer), but on the other hand, a PSA of 5.2 is concerning. For post-prostatecomy men, a PSA of 0.2 is usually considered evidence of a biochemical recurrence.

Best wishes with however you decide to go,
Mel

Layman comment: WPRT to entire pelvic floor and pelvic lymph nodes; see SPPORT trial.

Personally, I would think hard about ADT at 87: None or short course.

At 73, I had short term ADT w/ SRT post RP. And the ADT had an impact that I found "unpleasant". Tx has been effective for almost 3 yrs; undetectable PSA so far.

As heavyphil noted, ADT usage seems to be moving toward less or none in older, longer to recurrence patients.

Consider a 2d opinion from a Center of Excellence.

Best wishes.

This blows me away: "25 years" without issue, and the cancer STILL reared its ugly head again. Unreal. I just pray that I never have to cross this bridge, but if I do have BCR at some point, and I am presented with the recommendation for ADT, I will decline....ADT is my "line in the sand." You are literally messing with your brain...the hormonal control of your body...when on ADT. I've even hated the handful of times that I was on Prednisone in my life.
Jeff Marchi is well-respected here on this blog...I would go with his recommendation...with the approval of your physician of course, who has to write the Rx for the Nubeqa.
May last thought is that being 87 years of age, has your physician told you how long you might survive if you don't take any meds or do anything else? What is the history of longevity in your family? If you could hit 95 - 100 years of age with a good quality of life "without" medicine, and a slowly growing return of your cancer, then I wouldn't do a thing. Good luck to you.

@melvinw
Dear Mel,
thanks for the extensive replies. I also think that I shall consult different people before deciding what to do. Actually, my PSA was never close to zero over the years: well below 1.0 from the beginning and rather static for about 20 years. I noticed a linear increase in the last four years: four units in four years. I have read that exponential growth is dangerous, so in my case I do not have it. The PET activity identified also linphonode activity in the pelvic region, so perhaps something has metastasised. I also feel that ADT is really too heavy with SE so it may be useful in more aggressive cancer cases, while focussed, rotating photon beams may be less damaging in the long term. However, since all data indicate slow growth of this type of tumours and I am 87 years old, should I not let sleeping dogs lie? Something else will keep me within life expectation in the actuarial sense!
FAG

@fag
The problem is, Prostate cancer tends to go to the bone. It then become becomes quite painful. You Don’t want to be in that position.

My father died of prostate cancer at 88. I remember when he told me Lupron stopped working, but I didn’t know what it really meant at the time. There was no other solution. He had his teeth ground down and crowned without Novacaine When I was a teenager. He came home at night after he had it done and ate dinner with us. An incredible pain tolerance. In the last few weeks before he died, he was on so much morphine he couldn’t communicate. The pain was just that severe.

There are options, Do you really want your last year to go like that?.

Dear Jeff,
Of course you are right: prostate cancer is slow but can go somewhere else where it will be faster indeed.
I will consult with various oncologists and make a decision: it is all very recent and mental processing usually takes time! My hunch is that ADT has worse consequences than IMRT: the first oncological group was pondering to use only radiation and not hormonal depressing therapy..
I shall certainly keep fighting since I am still busy working with my head: that is why memory losses and un-focussing worry me a lot..
Thanks for sharing your thoughts
FAG