After Brachytherapy, ADT and EBRT

If your PSA is RISING After your treatment, then yes, you may need to do further treatment. Just having a higher PSA, without it rising, may not be consequential.

After having radiation, it can take years for your PSA to reach bottom. If you worry when your PSA starts rising, it really has to have three rises in a row before you need to consider doing something.

Usually the treatment you had will eliminate the cribriform cells.

As for treatment, Get off that Firmagon, It makes people uncomfortable and there is no reason you have to be that way. A Lupron shot causes almost no Side effects, I got them for seven years and never felt anything after getting the shot. Even better get on Orgovyx, much simpler to take a pill then have that shot in your stomach.

If you find your PSA is rising after Continuing ADT, then you need a second drug, an ARSI like Zytiga or a lutamide. That’s because, If your PSA rises with ADT, then you have become castrate resistant. The second drug will almost always reduce your PSA back down to undetectable or at least as low as you can go after having radiation.

The biggest thing to think about is that it is not time to panic. Many people have gone through what you are going through and have lived for more than a decade before treatment has stopped working. You also have to consider the fact that new drugs are coming out all the time, So future treatment may completely resolve your issue.

I’m not sure where you’re being treated, If your cancer does come back, you need to be treated in a center of excellence or by a Genito urinary Oncologist. Those are the ones that can direct your treatment to the Best conclusions. You are beyond a urologist and a radiation oncologist at this point.

Wish you the best outcome.

Thank you for your comprehensive advice.

If you haven't had germline testing done to look for variants of significance in prostate cancer, that would be something to consider.

If you do need genetic testing

You can get it done free with the below link, if you live in the United States. Do not check the box that you want your doctor involved or they won’t send you the kit. It takes about three weeks to get the results and then a genetic counselor will call you.
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Prostatecancerpromise.org

Fortunately, I live in Ontario, you know, your friendly neighbour above the crack house. I am not sure that these interventions are available here, but I’ll inquire.

They are more likely to agree to genetic tests if you have cancer in your family. If you don’t know exactly what kind someone had you might find out before requesting testing from your doctor.

I would if I knew who my genetic donor was.

You ll always be a friendly neighbor. Try some white button mushroom powder in your coffee/ tea- studies are still in progress on this subject.

Here is a link that may provide some guidance on obtaining germline testing in Ontario given your cribform patholigy: https://pmc.ncbi.nlm.nih.gov/articles/PMC10581723/#:~:text=The%20objective%20of%20this%20guideline,optimal%20management%20and%20decision%2Dmaking.&text=Germline%20testing%20should%20be%20performed,(Moderate%2C%20LE%202).

I want to add how much I enjoy the phrasing of your posts, notwithstanding the seriousness of the content.
Bill

He does have a dry wit, doesn’t he? I always look forward to his posts even though, as you say, the subject matter is less than funny.