PT3B five years in, treatments - hope this info helps

Wanted to give update on our decision for treatment and hoping what we've experienced is of help to someone else. Been with Moffitt since starting adjuvant radiation in 2014 (after prostatectomy in 2013), then added Memorial Sloan Kettering to the team as of 2015. As you can see below, the PSA began to rise to a point where treatment was started. We consulted with both Moffitt and MSK and their best opinion based on their research was to start intermittently with Casodex at 50 mg daily. The optimal timing to start Casodex would be when PSA gets close to 10, but not above, then when PSA gets close to 2, but not below, to go off. From what we were told, the efficacy is best at this range, better not to overtreat, allows longer time on lower dose and delays the start of more aggressive treatment. Hubby is getting good response and only side effects have been tender breasts (but not gyneclomastia which we've discussed) and an occasional feeling of fatigue but not to a point where it hinders daily work/activities. We realize this treatment protocol is not for everyone. We also were told that Casodex is effective in only about 30% of patients. But it's what we chose based on two very respected prostate cancer oncologists' research and opinions. We know that this will change in the future, Nilandron will be the next therapy once Casodex is no longer effective, and then we'll again play the game of wait and see what happens.
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Age 58 at surgery
Sep 2013 PSA 3.7, clinical stage T1c, 3+4
RRP 10/31/2013, path stage pT3bN0Mx
SVI bilaterally (direct, not distal), LVI, pos margin at apex (3+3), EXE at base
4+3 w/ tertiary 5 (65% 4, 35% 3, 5% 5), tumor involved 15% of gland
12/2013 PSA 0.02; 2/2014 PSA 0.03; 3/14 PSA 0.02; 4/2014 PSA 0.02
06/01/2014 MRI/bone scan negative
06/01/2014 PSA .03
07/01/14 to 8/27/14 - 40 sessions adjuvant radiation
11/26/2014 PSA .03 - three months after radiation
02/25/2015 PSA .05 - six months after radiation
05/21/2015 PSA .17 - nine months after radiation (referred to Med Onc at Moffitt)
07/20/2015 PSA .41 - more than doubled, classified "incurable, micrometastatic"
10/05/2015 PSA .47 - slowed down considerably; MSK opinion same as Moffitt, wait and see
01/06/2016 PSA .62 -
03/30/2016 PSA .93
08/08/2016 PSA 1.7 - med onc says wait and see
11/02/2016 CT scan pelvic, bone scan - both negative for mets
11/02/2016 PSA 2.82 again wait and see
02/12/2017 PSA 3.86
05/04/2017 PSA 6.07
07/17/2017 CT scan pelvic, bone scan - both negative for mets
07/17/2017 PSA 6.6 (started 50 mg Casodex daily per Moffitt, MSK wanted PSA closer to 10)
09/01/2017 PSA 2.62
09/22/2017 PSA 1.97 (stopped Casodex after 58 days and drop of 4.63)
02/13/2018 PSA 8.8 (started 50 mg Casodex daily after 150-day vacation and 6.83 rise)
04/02/2018 CT scan pelvic, bone scan - both negative for mets
04/02/2018 PSA 3.6
04/13/2018 PSA 2.76 (stopped Casodex after 56 days and drop of 6.04)
08/16/2018 Next PSA scheduled

Thanks for sharing. You guys have been through quite a bit. With an initial diagnosis of a T1C and Pre-tx psa of only 3.7 and a G 3+4 , it’s pretty unfortunate to not see your hubby in the “cured” state. The path report definitely didn’t help.
Hoping the PSA stays low.

ADT was not started after prostatectomy and before radiation because the oncologists believed they were going for a cure with radiation. The thought was that any residual cancer was still in the prostate bed. However, it was later realized that the cancer was systemic, already in his blood stream/lymphatic system even before surgery. We consulted continuously with both MSK and Moffitt after each PSA result and what should be next steps. We waited for a PSA doubling time to be the determining factor, hence the reason Casodex was started at 6.6. (Our doc at MSK felt that this was a bit premature and should have waited til closer to 10, but future stops/starts will be in the 2-10 range. All based on the latest research for intermittent therapy.) Only time will tell how hubby's body will react to each method of treatment. It seems therapies have changed a great deal in just the five years we've been dealing with this. Our hope is that it'll continue to change and delay or even avoid the use of stronger meds. Best to all. Never give up - never surrender!