Given the PSA post surgery, your clinical data indicates there was PC outside the prostate.

Interesting that your SRT was to the prostate bed only and monotherapy. Various studies tend to say treat the prostate bed, entire PLNs with radiation and add short term ADT, six-24 months. Oh well, history as they say, can't change it, learn from it.

Generally, advanced PCa is not "curable." Question is, if we shorten our horizon to 3-5 years, can we "live" with it? Other diseases do, diabetes, AIDS...the changing landscape of treatments for PCa may very mean for most men with advanced PCa, they may be able to.

In your upcoming meeting consider discussing doublet therapy, radiation and short term ADT, six months. You may have micro-metastatic PCa which is too small to be seen by imaging, your PSADT supports that. The ADT treats that since its systemic therapy. When discussing radiation, bring a radiologist into the discussion and talk about treating the entire PLN system vice spot radiation to the one site identified in the imaging.

The PSADT you provided supports being aggressive, the general rule of thumb:
> 12 months actively monitor
6-12 months grey zone
< 6 months treat now.

As you can see from my clinical history, when surgery and SRT (to the prostate bed only, the standard of care at the time...another story) failed, my PSADT indicated as my surgeon and urologist said, "Kevin, I don't like what your PSA is doing...!" I was fortunate in that the C11 Choline scan showed only PLN but no bone organ involvement and triplet therapy has given me a durable progression free period.

Finally, take some time to read through the NCCN guidelines for patients on advanced PCa, Chapter 7 - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=50

Kevin

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