Well, the dilemma is treat too little, treat too much...balancing quality and quantity of life given the toxicities and side affects...While there are some who say advanced PCa can be cured in some cases, others say no, it's a lifelong thing you and your medical team have to manage.

Something to consider...my medical team knows not to recommend lifelong ADT, rather, when it reoccurs, we have a defined treatment plan for a defined period, the decision to stop treatment at the end of the defined period is based on the clinical data. When we decide to stop, we have a plan to actively monitor and decision criteria to start again.

You can see evidence of that from my clinical history, triplet therapy starting in January 2017, ending in May 2018. We had planned on 24 months of Lupron but Dr, Kwon was ok stopping at 18 given my response. That brought 4-1/2 years off treatment, T returned, life was good, well it always is...

This year brought the data in our decision criteria, three or more consecutive increases, PSA .5 to 1, so we imaged with Plarify, based on the clinical data, did SBRT and for now, six months of Orgovyx. My oncologist originally wanted to do 24 months of ADT, Orgovyx and an ARI, Xtandi. He changed his mind because of the concerns of the side effects associated with Xtandi and wanted to see the PSA response to the SBRT and Orgovyx. He tested at six week, at our consult he decided not to add Xtandi given the PSA response, wants to test again at three months, if PSA continues to drop, he won't add the Xtandi and test again at six months, then decide based on the clinical data. His thoughts at our first consult were 24 months, now he wants to take it in three months segments and decide though he is leaning towards 12 months of Orgovy only, then stopping and actively monitoring. I'm ok with that.

He is not wrong though the growth you describe in the prostate bed while on treatment would be bothersome to me. As you can see from my clinical history, I have three separate go rounds of radiation treatment, no side effects, attributed to the sophistication of the planning and delivery software, equipment and training and education of my radiological team. Using a 3-5 years window as your framework for decisions on managing your PCA allows for control while newer treatment options come into mainstream clinical practice, thus living with PCa as a chronic disease.

Kevin