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6 months or 18-24 months ADT with salvage Radiotherapy

Posted by rad62 @rad62, Mar 8, 2023

After RARP in 2019 my psa is back up to 0.26 from 0.02 post op.
After PET/PSMA scan right common illiac node showed possible tumor infiltration (SUV-1.9)
I have now decided that the best treatment option for me due to high risk pathology is Radiotherapy combined with ADT.
My question is now, 6 months or 18-24 months ADT.
Research i have found seems to suggest 6 months maybe long enough and give better return to normal testosterone levels and life quality in comparison to 18-24 months.
My radio oncologist is pushing me for 24 months but i am not convinced there are benefits over 6 months.
Would be very helpful to hear peoples experiences in regards to this subject and any links with latest studies e.t.c.
thanks.

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samidh | @samidh | Oct 26, 2025
In reply to @sbd "@samidh Thanks a lot for your detailed response, sir. This is important and valuable information, as..." + (show)
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@samidh
Thanks a lot for your detailed response, sir. This is important and valuable information, as we prepare my father for Tomotherapy radiation. Tomotherapy doesn't seem to be a common choice in the western world.

It has been a highly emotional, obsessive researching weeks/months for the family, now we seem to have some level of acceptance, some direction.
Might bother you more at a later point in time. Meanwhile, as you said, we will learn to live each day with more joy, affection and with a smile! Take care.
PS: This is a great forum, of support, of inspiration! Keep fighting, keep smiling everyone!

God bless.

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@sbd
Just send me a message anytime, and I'll get back (I don't actively log into this forum every day).

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samidh | @samidh | Oct 26, 2025
In reply to @jimgaudette "I had salvage radiation and six months Lupron in 2019. My testosterone came back to 400..." + (show)
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I had salvage radiation and six months Lupron in 2019. My testosterone came back to 400 in three months, but my cancer came back in two years. I then had five radiation treatments to a lesion on my sacrum and three years on Lupron and Abiraterone. My PSA has remained undetectable for over four years, but my testosterone is only slowly returning in the one year that I have been off ADT. We are all unique and nobody knows how our bodies will react, but your doctor is probably more interested in stopping the spread of your cancer than your testosterone levels and the difficulties no or low testosterone brings. I am 74 and otherwise healthy, eat healthy and exercise daily for at least an hour.

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@jimgaudette
You’re absolutely right, each of our bodies is unique. Measuring testosterone levels doesn’t seem to be part of the standard treatment protocol here in India; my doctor never suggested it, and I’ve never had it tested. Perhaps such considerations don’t hold much relevance for Indian doctors; they’re usually content as long as the PSA remains under control. But I have a pretty good idea what the result would be; my body tells me it’s still zero, even a year after stopping the drugs!

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trchar | @trchar | Oct 26, 2025

It’s way too low for a PSMA/PET to render any tracer of metastatic activity. Best avid tracer after treatment is .9 to 2. So I guess his/her thinking is nothing is going to show up on that type of scan. It seems like you have to wait for an infection point to begin a course of treatment once again.

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jimgaudette | @jimgaudette | Oct 27, 2025
In reply to @samidh "@jimgaudette You’re absolutely right, each of our bodies is unique. Measuring testosterone levels doesn’t seem to..." + (show)
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@jimgaudette
You’re absolutely right, each of our bodies is unique. Measuring testosterone levels doesn’t seem to be part of the standard treatment protocol here in India; my doctor never suggested it, and I’ve never had it tested. Perhaps such considerations don’t hold much relevance for Indian doctors; they’re usually content as long as the PSA remains under control. But I have a pretty good idea what the result would be; my body tells me it’s still zero, even a year after stopping the drugs!

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@samidh From what I’ve read, testosterone comes back or doesn’t depending on age, general health and length of time on the drugs. My first time was six months and testosterone came back after three. I am hoping that since this last time I was on them for three years, my testosterone will be normal in 1 1/2 years. It is 100 after one year. 200-700 is considered normal.

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