Adjuvant RT and ADT after RP

My opinion is that given Gleason 8 and PCa confirmed in a lymph node, I would plan for RT+ADT by the time that PSA reaches 0.20. The additional information provides you a doubling time before treatment. It is not probable that a PSMA PET Scan would detect PCa tumors at that PSA level, but I defer to others in this forum either more data on this topic. I also defer to @jeffmarc on the tradeoff between waiting until tumor(s) could be detected on a PSMA scan versus long term prognosis for waiting until after BCR 0.20 to begin treatment.

The fact is that jump in PSA is really pretty irrelevant. You need to see the next PSA or two PSA tests to see if you’re really having a rise. You should be getting tests monthly to see what’s going on.

I like the fact that your doctor is being proactive. Adjunct radiation has been shown to make a big difference for some people that have a combination of issues. I’m not sure what your specific issues are, but here is some information from a real Genito Urinary Oncologist Who is one of the top people in the field?

Take a look at the following, which tells you which patients should have early radiation (adjunct), See if Your situation matches what she has described. If this doesn’t match your situation, talk to your doctor about this. You did not supply enough information for us to advise you.

Dr. Efstathiou concluded as follows:
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

See SPORRT Trial

Absent definitive PSMA PET scan evidence of metastasis, the belief is that there are residual PCa cells in the prostate region.

WPRT - whole pelvic region treatment together with pelvic lymph nodes is the treatment that I received: IMRT radiation 66.6 gys and Short term ADT.

Best wishes.

@jeffmarc
Thanks very much! This is very helpful. Btw - my TNM stage is pT2cN1Mx

This is a great place for getting information, but have you thought of getting a second opinion from a reputable cancer center like MD Anderson, Mayo or Memorial Sloan Kettering? There're probably others equally qualified but getting more professionals involved isn't a bad idea. Don't be afraid of your doctor taking offense, after all it's your life and go after this with gusto. My doctors were happy that I got other opinions.
You only have one life, so fight with everything you have.

Just my 2cents here. I had RP in August, my PSA was 4.01. The Biopsy had my Gleason at 4+3 unfavorable with my Seminal gland slightly affected. My urologist sent me to an RO who told me that he expects my PSA to be zero in November and doesn’t expect it to change but if it starts rising he would first do another PSA test to confirm and then start making plans if my PSA went to .1, by the time it reaches .2 we will already be starting treatment. He told me the pet scan will not show anything till .7 which is too late. He also said that the complete prostate bed would be treated with a focus on where the cancer was in my Seminal gland. For now I am waiting for my first PSA after surgery, not on ADT. The surgeon took lymph node samples and all my margins were negative.

@jeffmarc
Great article. Thank you. I am trying to figure out what this says about my next steps given I have the following risk factors: pT3b disease. Decipher score of .75. My first PSA test after surgery will take place the first week of November.

Should I consider additonal treatment regardless of what my PSA is, or only if it is above a certain threshold? If so, what is the threshold? What treatment does this study recommend in my case? What are the typical side effects of the recommended treatment?

I appreciate any clarifications for my specific case.

Ater re-reading the article, I believe - given my risk factors of pT3b disease and a decipher score of .75 - I might benefit from adjuvant radiotherapy which is typically adminstered within one year of surgery and before the PSA starts to rise.