When can ADT be safely avoided with salvage radiation therapy?

I know I just wrote an article about the benefit of adjuvant ADT with salvage radiation (SRT). Well, there may be an exception for men who get SRT early enough after a recurrence and don't have aggressive pathology.

/pcnrv.blogspot.com/2018/01/when-can-adt-be-safely-avoided-with.html

In their analysis, they found that adjuvant ADT only benefited those with T3b/T4 and GS 8-10 getting early SRT for a recurrence. Every patient has to consider what risks and toxicities he's willing to put up with.

J&D-

None of this applies to your situation. A uPSA at 9 months of 0.012 is excellent, as was his post-op pathology! I frankly avoid playing this "what if" game you seem to be into and recommend you find a way, using Mindfulness and psychotherapy (as I have) to stop doing it - it is destructive.

My RO at MD Anderson advised that ADT wasn't necessary, and I wasn't going to ask for it. I started SRT early, psa only .023. I was a T2C but with high volume involvement and multiple positive margins. It seems to be working so far.

My oncology urologist that was trained at MD Anderson told me that ADT wasn't warranted for me. He stressed that he only gives ADT on GS8 and above.

I was destined for adjuvant RT after my not so great pathology. My plan is to avoid ADT for as long as possible. I think watching ultra sensitive PSA numbers would drive me insane.

Jack & Diane said...
I'm so confused. TA, what about the fact that our RO told us that she feels he is going to need treatment at some point, maybe not yet, but at some point is what she told us. Also his PSA did go up from <0.006.

When I look at the post surgery PSA of JFL1957 (above) he had PSA increases from <.006 to .014 at 16mths then started SRT at a PSA of .023 at 19mths.

I'm just trying to learn what I can ahead of time based on what the RO said and when I see people like JFL. Can I really be that off base? Trust me, I would love it if I truly was, this is THE worst thing to ever happen to us.

Jack & Diane, It sounds like the RO is giving her gut feel from the loss of undetectable PSA, while Allen is saying that she shouldn't have said that because statistics show that recurrence (as defined by 0.2) is still unlikely. Indeed I have seen various signatures in this forum, where ultrasensitive PSAs continue at low detectable levels for years, never rising to 0.2 There is some suggestion of "Early SRT" at above 0.05 but you are not there yet either and its controversial. In fact PSA seems to have come down a bit.

Certainly in my case, I would have been an early SRT candidate because my PSA rose to 0.059 except that I knew that it was only one brand of PSA assay that gave the result and 5 other brands of PSA Assays showed undetectable. It took me awhile to get used to the fact that I am not a "perfect case" of a post RALP outcome, but over time, I've gotten used to thinking that its still unlikely that I will have recurrence.

At 0.012, you can't do anything about it at this moment and it might be 6 months or 6 years before PSA rises to an actionable level. It may even become undetectable again. I think it was fine to see the RO to discuss it. I did that as well. However, for me the key thing was learning to live with the uncertainty in such a way that I wasn't stressed about it. I have 100% gone back to my old life. Only difference is that I keep an eye on this too once awhile.

Thank you so much WeightLoss and Skypilot56! Every time someone takes the time to respond to me I really take it to heart and I do my best to take the advice. I have learned so much here! I try to enjoy/value every moment. Sometimes, I do think how different it was when he was <0.006 because I was way less worried. During that time, I did tell myself “enjoy this moment” because it could change at any time. I'm still telling myself that now, but there is this weight on my shoulders, more like a fear I guess.

When the RO said she feels he will need treatment I was surprised to hear her say that right out of the gates, but that is why I was there, to hear what she thinks, just wasn't expecting to hear that so quickly. What helped keep me sane is that I trust TA and I kept thinking of what he told me about anything under 0.03 not being prognostic. Don't get me wrong, I'm not saying he's not ever going to need SRT, I'm saying I must always have hope and faith I guess.

I understand that there’s nothing I can do now except pray and wait so that's what I'm doing. I will however continue to try to stay a step ahead and keep myself as educated as possible.

TA, I know I can be annoying with my repeated worries. THANK YOU for your continued advice and for not giving up on me. A bit OT…I want to tell you that I believe in mindfulness, but I'm not very good at it. A few years ago I attended a 3 hour introductory class. At first I was very skeptical, but by the end of the session I had pages and pages of notes. When I returned home (took the class during a business trip) I tried to find somewhere to take instructor led sessions with my husband but could not find anything local.

It’s too bad that they don’t offer this together with nutritional guidance as a program for cancer patients and their families. Before my husband was diagnosed I’d drive by these large cancer centers and assume all of this stuff was inside, making everything as easy as possible for those with cancer. Boy was I wrong! It’s not like that at all. You’re really left on your own to figure stuff out and make huge decisions. There are no easy, one size fits all answers, let alone someone waiting at the door of a cancer center with a handbook telling you how to make these decisions and how to cope.

That’s why this place is so near and dear to me. I wish nothing but the best for everyone here, you guys are amazing!

Allen, are you familiar with Headspace? If so, what do you think of it?

Yes, ive had the free version for a while. In December they were offering a 1 year subscription at 40%/ off, and they sucked me in

I haven't been consistent enough. Still working on it. But it is calming when I'm doing it daily, and I've found once or twice that I've caught myself getting real nervous over something and realizing it, and thinking about it, and calming myself down. so maybe it's working. I need time to stick with it

Thanks for posting that. At the time of my SRT, there was not much data on SRT +/- ADT (not that there's that much now). My urologist leaned a bit towards ADT because he thought that would weaken the cancer cells before they were nuked. When I said that to my RO he said that may be true, but he could also make the opposite case. That you want the cells active and trying to divide instead of dormant while being nuked. The paper you posted indicates that, in my case, my RO was right. And I never had to deal with ADT SEs.

Thank you so much! I watch GMA and have heard him talk about it. I will get a copy.