Connect
What's Next After SBRT and ADT?
Gleason 4+3. 5x SBRT end of November 2025. Started Orgovyx November 1st of 2025. I just came off 6-months of Orgovyz on May 1st. PSA is now undetectable. 65-years old.
My question is what's next? Seems like the more I read the more the reoccurrence probability goes up. I know monitoring is critical but what's the game plan to PREVENT reoccurrence? My docs and the rest of the healthcare world are not into preventing, only treating. I don't want to sound negative. I am incredibly fortunate on many fronts and doing great. I am continuing rigorous strength training and improving diet. What else is everyone doing to PREVENT reoccurrence.
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
What’s next is getting PSA test every three months for a couple years and then every six months for the rest of your life.
With the 4+3 it may or may not come back? A decipher test will give you an idea if you are likely to have it come back.
I was a 4+3 and I’m still around after 16 years. I had surgery 16 years ago at 62 and radiation 12 years ago.
The drugs we have today keep me alive and better ones are being developed All the time. You have a long future to look forward to.
-
Like -
Helpful -
Hug
6 ReactionsNot to be a downer, but the number one proven way of preventing prostate cancer recurrence is to die of something else before it happens. That counts as treatment success in all of the statistics and why long-term studies only count prostate cancer specific deaths. Since most prostate cancer occurs in elderly men there are more deaths from other causes than prostate cancer in the 15 to 20 year longitudinal studies.
-
Like -
Helpful -
Hug
3 ReactionsYou're in a very favourable bracket for non-recurrence. Your cancer was caught early, it was only Gleason 7, you had both SBRT and ADT, you're still relatively young, and your PSA dropped to undetectable quickly. Obviously, life doesn't come with guarantees, but IIRC your odds of surviving long enough to die of something else or old age are somewhere in the 95%+ range, unless you have some dangerous genetic mutations or the cancer is unusually aggressive (and even in those cases, there are excellent treatment options these days).
You're absolutely right that a healthy lifestyle -- good balanced eating and activity, managing metabolic health, etc -- is the best thing you can do for yourself right now. And, as @jeffmarc mentioned, frequent testing (every 3 months at first, then maybe drop to every 6 in a couple of years if all seems well).
-
Like -
Helpful -
Hug
2 ReactionsWe’re all in that same boat; some of us even on Round 2 and asking the same question: ‘What’s next?’ Well…
ADT, lutamides, SBRT, Pluvicto, Chemo…
All singly or in combination.
So don’t worry, Science has you covered!😉
The problem with recurrence is most is out of our control. The two largest factors are genetics (Decipher test mentioned can give you some insight on your situation) and how through your treatment was (positive margins on surgery, misses on radiation, or undetected micro-metastasis that PSMA PET could not detect). Read the Active Surveillance - Systematic Review post for information on lifestyle actions (the poster also has a website that covers many supplements, etc.). Exercise and diet seem to have the most impact and you have those covered. From a medical standpoint more ADT will reduce if not eliminate prostate cancer recurrence, but studies have shown that the increase in all causes of death from the ADT side effects out weights any population benefit from decreased prostate cancer death. Unfortunately, there are more snake oil cures or preventions for cancer than just about any other disease. People like to be in control, even if it is an illusion. If one of these cures gives you a sense of comfort and control than go for it. Just keep the PSA testing current with everything else you do.
For your current situation your PSA is still being suppressed by ADT and may be until early August. It is not unusual for PSA to become detectable again once testosterone returns after radiation and ADT. PSA remaining under 0.25 is predictive of a low recurrence rate while > .50 has significantly more recurrences.
There isn't a thing you can do that I am aware of. I am 4 years in and after removal went BCR after 2 years. Onto radiation and adt and 6 months post tx. undetectable. One year test coming up in July. It appears you are taking care of your body the best that you can. This is an unpredictable cancer that can lay dormant for years then pop back up out of the blue. While it is always somewhere in the back of my mind, I can usually deal with it by staying present in the moment and current day. Stay busy, live your best life and keep going is my suggestion.
@jim18
Yes, Jim you are right. Deaths from other causes do slant the statistics when claims are made that ADT's help. There are even studies that show ADT's harm all men and help a few, but the studies fail to show the price we pay due to heart, muscle, and bone damage. The studies typically ignore the down sides of ADT treatment. They always seem to only mention hot flashes as the primary side effect while ignoring the life-threatening side effects.