6 months or 18-24 months ADT with salvage Radiotherapy

I had a RP in April 2018 after being on Active Surveillance for 2 years. My PSA was undetectable

I will try to repost as it is only showing my first line.

Here's my clinical history, emphasis on my, not yours, this is a heterogeneous cancer.

After surgery and SRT didn't work, Mayo and Dr. Kwon recommended triplet therapy. The ADT was planned for 24 months. Dr. Kwon agreed that 18 months was sufficient given my response to treatment.

You can find various articles on studies about the length of time on ADT for SRT. Some will say six, others 18, 24. 36...

So, your decision, in conjunction with your medical team. Part of that decision is your personal preference, minimalist versus maximal. Do you want to go the "nuclear" option route or simply fire a few rounds and see if that "neutralizes" it? For me, given my clinical data, the pathology report, the failure of surgery after only 18 months, the failure of SRT, the PSADT and PSAV led me to the nuclear option.

You don't have my PCa and the clinical data which informed my decision.

You could do the six months, then assess, if the treatment has worked, PSA decreases to undetectable, scan shows decrease or absence, then actively monitor. If the treatment has not produced the results to inform a decision to stop, you could continue go 18 months, assess...

If you have not already, discuss with your medical team using Orgovyx - https://www.medscape.com/viewarticle/942933#:~:text=The%20US%20Food%20and%20Drug,oral%20gonadotropin%2Dreleasing%20hormone%20antagonist. It does not have the flare of Lupron, faster to castration, higher rate of sustained castration while on it, lower CV profile and faster recovery of T when stopping.

Kevin

Thank you for the information.
I am in Europe so not sure if different meds are used here.
After deciding not to wait I have a new appointment with the social health care radio oncologist march 29, I will discuss it with them, and see what they propose.

We have an MD Anderson Cancer center in Madrid
( connected to that of Texas)
I believe my insurance covers me there so I will also be consulting with them.

My Radio Onco put me on ADT and only three months after commencing ADT did he start 20 sessions of Radiation (3 units x 20 fractions). He wants me to continue ADT for 2 years.

Thanks for the information,how are you coping with side effects e.t.c.

I am being aggressively treated at UCLA for Gleason 9 PC that had only spread to the seminal vesicles, had RP, was on lupron and Erleada for 13 months. I personally am in favor of aggressive treatment and the side effects of the treatment so far have been manageable. I am 75 and I am hoping to be around for another 10 years. I have recently retired and I worked long and hard to get to retirement. I feel that retirement is the dividend to my years of work. I want to enjoy this dividend and not lose it to this damn cancer. So I always opt for aggressive treatment and aggressive frequent testing given by my UCLA doctors while being mindful of the reasonable quality of life issue. My quality of life is less than pre cancer, but still damn good.

hbp,
My husband recently had RARP at USC and his path report also showed seminal vesicle involvement. He is a T3b.
He was started on Lupron 6 weeks pre-op.
My question to you…what is your “aggressive”treatment? I am trying to find some information on the treatment in our future. My husband is 73, recently retired and we have many plans in our future and we don’t want this to get in our way.
We have an appointment with both our radiation oncologist and medical oncologist in the next few weeks.
I would appreciate your insight.

My perspective is you are off to a good start. Medical Schools + Research tend to be on the leading edge.

BillyH. My aggressive treatment is part of a clinical trial at UCLA medical school and hospital. I had 6 months of ADT ( lupron ) and Erleada, then 1 month break when I had RP, then 6 more months of Lupron and Erleada. Now they monitor my PSA every 3 Months and they are taking a pet scan in the first 3 month monitor period. 13 months after the ADT, Erleada and RP my PSA was .01 and testaterom (sp) was also very low. If my PSA or pet scan results create a concern, I suspect that they will put me back on ADT and Erleada, which I tolerated satisfactorily.