Unusual Treatment Plan?

that sounds realistic of your doctor.

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

If you have no other clinical findings in the bones etc and If the location of the tumor was only in the prostate bed then radiation to the prostate bed pelvic area and lymphnodes would seem a good choice and is the generally accepted treatment for recurrence after RP.
I too have a recurrence after surgery Gleason 9 and had 1 pet positive lymphnode,I will be starting radio therapy and 6 months adt. Yes there will be side effects to the treatment but like you I'm still relatively young (61) and want to be around for a while yet, so I will take the treatment in hope of a long remission or even a possible cure.

Glad to see your doctors response. Quality of life IS A BIG DEAL. and if you can wait and see. Sounds like what I would do in your situation.

Yes - my Dr did offer radiotherapy as an option, but didn’t really seem to push it at all. I am interested because it seems like the technology has come a long way in a short time. My problem is that I live in Mexico and have no health insurance. At present, it seems like the very precise machines are not available here. I suppose I could sign up for Obama Care and go get treatment in the US. I have applied for disability insurance with the SSA, if that is approved I will be eligible for Medicare fairly soon and could go that route.

Kevin, very detailed and informative and helpful. The 3-5 year window is a useful tool and helps to keep a good attitude. Thanks

ddl - My case is a bit similar. I had a Gleason of 9 ( 5+4) in 2015. Radical prostatectomy with clean margins and we thought we got it all. On year later, my PSA returned, and I underwent 7 weeks of radiation followed by two years of daily 150mg dose of Bicalutamide. This was an unusual treatment at the time, but a standard of care in Europe. I had 14 months of undetectable psa. It then returned and we did a Pet Choline scan and found three small tumors in my pelvic lymph nodes, and I started intermittent treatment with a three-month injection of Leuprolide and three months of daily 50mg bicalutamide. I got one-year undetectable psa from that, and it returned again. We repeated and I only got 6 months of undetectable psa. I will repeat again this week. This intermittent treatment has been effective at keeping the cancer at bay, while also allowing my body to recover and minimize loss of my muscles and bones. At some point we will either add an additional/alternative drug or go to continuous treatment. It has been 8 1/2 years now since first diagnosis.

Breaking News: FDA Approves Talazoparib + Enzalutamide for Metastatic Castration-Resistant Prostate Cancer
The FDA has approved a new medication, talazoparib, in combination with enzalutamide for patients with metastatic castration-resistant prostate cancer (mCRPC) who also have mutations in certain genes involved in DNA repair. This means that patients with mCRPC (prostate cancer that has spread beyond the prostate and continues to grow despite low testosterone) have an additional treatment option. https://www.pcf.org/c/breaking-news-fda-approves-talazoparib-enzalutamide-for-metastatic-castration-resistant-prostate-cancer/