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Salvage radiation decision: with or without hormone therapy?
I had a prostatectomy in 2021. PSA was undetectable for 2 years. Then PSA went to 0.1 in 2023, and then 0.2 in 2024. I saw an Oncologist last month who recommends salvage radiation to the prostate bed. I will do that soon, but first need to make a decision on whether I should do hormone therapy with the radiation therapy. I have a family history of prostate cancer, and my PSA was fairly low (5.0) when I had the initial biopsy and diagnosis, which showed prostate cancer existed in all samples. The Gleason score was the bad 7. I had a PET scan and bone scan before surgery which did not show any signs of metastatic prostate cancer. So my question to the group is: should I do hormone therapy at this time? Or just do radiation and see if that works? I'm 64 and in good health.
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@brianjarvis
Hello fellow men with PC in one degree or another. Pre or post treatment options considered or completed.
As I was already on “TRT,” TESTOSTERONE REPLACEMENT THERAPY FOR 12 years before my RALP, I had to stop my “TRT” a month prior to my surgery and 5?months following. Due to other debilitating health conditions, ADT would never be a practical or workable solution for me. Every patient is different and generates specific treatment options based on his medical history and preferences for the future.
If I don’t utilize “TRT,” my Testosterone goes down between 20-90, essentially making me medically castrated without the treatment for it.
More men need to do a lot more research on Testosterone and post PC surgery. The more recent and current research is much more informative and accurate about this issue.
Firstly, all men have Testosterone. Secondly, not every man develops PC.
It’s true that while you have PC, you should not feed your cancer with Testosterone. However, assuming they removed all of the detectable cancer, there isn’t any more cancer cells to feed. In other words, by removing your PSA FACTORY, your Prostate, you are essentially like a Nan who never had PC.
Many men utilize “TRT” and never develop PC. After a successful removal of your Prostate and all of the detectable cancer, you are able to utilize “ TRT!”
Of course, you monitor your PSA and Testosterone with along with all of the other essential markers and indicators to make sure you have not incurred a Biological Reoccurrence of your PC. Between 30%-40% of the time within the first 5-10 years following a successful Prostatectomy, PC returns for men.
Obviously, the huge majority of men in this category are not utilizing “TRT!”
Every individual has to do their own research. ( I am continually surprised how many men do not or do nothing more than a cursory review etc).
The reason I took the surgical route initially is so I could use the Salvage procedure if need be at sometime in the future.
There is no right or wrong way to treat PC. Their is what you and your physician and other advisors determine to be the most appropriate way to treat your PC and.how to continue with whatever post PC treatments everybody finds to be in their best interest.
In short, there are absolutely “NO GUARANTEES” about what your individual case of PC will or will not do after your initial treatment protocol.
The best thing you can do is to stay on top of it and monitor your situation so you can act accordingly if need be at some time in the future.
Thankfully, I had my RALP performed in October of 2022 and remain in remission. My PSA has remained steady at < 0.014 since my surgery and continues to do so through December of 2025.
Again, depending on what you believe. Some people hold the view that regardless of whatever kind of cancer you have had and it currently have. You are either in a state of remission or you are not. There is really no such thing as a “Cancer Cure!” Once you have cancer you deal with it for the rest of your life in one way or another or in repetitive ways over time.
This not a negative statement but one of fact.
I hope I remain in remission the rest of my life with PC and I certainly hope I don’t develop any other form of Cancer. Just as I wish for any man or woman dealing with whatever type of Cancer(s) they are dealing with now.
Hope for best but always be prepared for any other developments.
GODSPEED
My bet would be to take the hormone therapy. You can look up the issue in terms of it "radiosenstizing" the tumor or lesion which as I understand it assists the radiotherapy by making it harder for the cancer to repair its DNA which the radiotherapy has whacked. Also there's the possibility of micrometasis in some of the nearby lymphe nodes that PSMA PET can't detect
Look on it as an insurance policy. But talk to your Doc, bearing in the Doc's done a lot of this and it may be more of an art than a science
@melvinw Mel - thank you for reaching out to me and sharing your IMRT experience. I read your other post too, and your comments are very helpful and fill me with hope! I know I'm taking on additional risk by choosing no ADT, but like you, I believe the benefits outweigh the risks in my situation. I wish it wasn't such a grey area, and I know I need to get more comfortable with my decision, but at times I still have second thoughts about whether or not ADT would have been a better course.
When do you get your first PSA test after IMRT? It seems like that will be the key indicator of success. Since you are not on ADT, does your Oncologist still expect your PSA be < 0.1 after finishing IMRT, or will it take time for the PSA to drop?
Also - I printed the article you sent from the VA on the "full bladder/empty rectum diet" and I think it will be a very helpful resource as well. I just finished day 5 of 38. No issues so far. Fingers crossed!