genomic classifier and/or adjuvent/salvage radiation?

Many wise & experienced heads here - I'm hoping for some sage advice -

Urologist, MO & RO all seem to want to hold to see whether PSA approaches 0.1 - and are not presenting radiation now as an option.

It's a significant goal for me to postpone HT for as many years as I can.

Should I be asking about sending sections of prostate for genomic classification? If so are there alternatives, any specific one folks recommend?

Would anyone here recommend radiation of the prostate bed now - given G7, PNI+ and EPE+, .02 PSA?

Any other testing I should pursue?

Maybe I've been reading too many medical journal articles?

Thanks for any guidance - appt with urologist tomorrow (Tuesday).

.02 isn't much PSA.

The traditional wisdom is that you wait until .1 and hit it no later than .2. Radiation has it's side effects too and you aren't that far from surgery. I'd wait for at least one more PSA test before rushing to the radiation room.

There are studies that suggest earlier is better, but I wonder if you are erring on the side of panic rather than sound medical theory. Why are you assuming that you'll need HT? Is that based on your doctor's opinion or your own?

I think you need a little more patience - wait 3 more months and see if the PSA rises again.

Andrew

Wait till official bcr,.2 better yet wait till MSK's official bcr of .4. . 3+4 is low side intermediate risk. Yes I see your Postop of EPE positive. Did you have negative or positive margins. In other words did the surgeons cut wide and produce a specimen that was free of cancer outside of the inked margins. If they were negative, this would trump the EPE.{its in path report} Your psa could run back and forth for years in the .02. and yes the new "dreaded 03." .05. even higher, but below. the facts, also reported by
TA show mortality as not being affected by these early treatments. If I have misrepresented that, I will be corrected, hopefully. I respect your Uro in holding off till .1 and wonder in my mind if that is his protocol or is he slicing the difference in deference to your vibes, possibly created by as you say too many medical journals. Medicos are very susceptible to the silent communications of patients and may or may not react to it, especially if it creates more rather then less treatment the particular medico him self feels is required at the time or specific metric be discuss. Just something to think about. Your Uro is in no rushh to judgment, maybe you shouldn't be especial based on a forum's advice, regardless of our medical "wisdom". Mine included. The choice affects you…not your medicos, and certainly not a bunch of guys on a forum, even as "wise and experienced" as we are. My personal feeling is that your case is not as serious as you think it is. A positive margin rather than negative would del that opinion a bit, but watch the psa. Srt at this point is well, imo, pointless.

How silly! Not you wilderness, that is for the phantom, {private joke}

Thank you for your responses & helpful advice logoslidat, Pratoman, Octorobo & Andrew.

I engage full-bore in anything that captures my attention/interest - just my nature. But it is only ~5% of my day on PC - not dominating my life.

Surgeon did dissect wide - negative margins though close at the apex. He's the surgeon New England doctors use, immense reputation in this region.

I appreciate this forum very much, hope that over time I can add value in return, though I'm too green to be much helpful yet.

Hi Wilderness,

I can only pass along my experience and what my doctors have me doing. They are inline with multiple papers from nih.gov on early start which helps my confidence.
As a 4/5 G9 with positive everything they kept me off HT to see what was happening after RALP. At 3 months PSA was <.01 rising to .1 at 12 months. It was time for HT/RT which they still consider early. The low number and slow rise strongly suggests METs are not yet an issue. Why did they wait? Healing and continence recovery are put on hold by RT and they didn't want my PSA hidden behind HT. I'm a few blocks away from you at Beth Israel with a good team from B&W Boston, Stanford, Barnes, etc.

Thanks, John_TX, NE-skier, Tall Allen.

Very helpful!

MO offered to meet to discuss Decipher and the UCLA study indicating SRT @ PSA .03 - will do that next month.

This forum rocks.

DRE clean at yesterday's appt. with surgeon. He is happy to call anything < .1 "undetectable", recalled the days when precision improved to .5.

Wilderness

Wilderness, I seem to be in your shoes too.  My 9 month uPsa came back .009.  This got me a bit concerned, as it did my doc.  He ordered the Decipher about 2 months ago.  I go in on June 5th for the results, and my 1yr post RP.  I'll be posting my results for forum input.  The comments I've read have been very helpful for me.  I think there are a few posters here that have used my clinic (Vanguard in Houston) and it seems, or I got the impression, that they pull the trigger at .03.