To radiate or not to radiate

"It’s my understanding preemptive radiation gives no better results than radiation given as a result of climbing PSA"

I don't believe that at all. the problem with waiting is waiting too long and finally pulling the trigger when PSA has risen, say, above .2. often this occurs because the surgeon doesn't prepare the patient and both go into denial as PSA ticks up. I've seen plenty of that here. I applaud your doctor for referring you to a radiation oncologist to discuss a back-up plan in the event it's needed.

Pull the trigger. Over treatment at this stage is not a bad decision.

What a terrific resource you guys are. Your input is very much appreciated. This forum is like the Cheers Bar of unfortunate disease! A comfortable place. Thanks again!

Dibs on being Cliff!!

My situation was similar to yours. RP. Pathology 3+4, pT3a. pN0. Negative but close margins.

My first PSA about 2.5 months post RP was .04. It fell to an undetectable level then bounced around a very low detectable levels. Latest was .01 but LabCorp has me at a consistent undetectable <.0006.

When I saw the initial .04 I struggled with whether I should go with ART. The surgeon's assistant talked me down and told me to watch for a trend. 3 years out from the RP I'm glad I listened. I'd rather not get roasted if I don't have to.

Will I eventually BCR? Chances are darn good I will. In fact, I expect it. That mental approach has eliminated my anxiety. The hardest part in the beginning was worrying whether I would or not. Now I've accepted the odds that I will. And if I don't - it's a gift. I don't stress out the week before PSA draws anymore. The anxiety went bye-bye.

That's my story. Everyone has to play the hand they're dealt in their own way.

Best of luck to ya.

Don't do what you don't need to do. Don't let microscopic fluctuations cloud your thinking. Later, if you have true BCR, there will be time to pull the trigger with SRT. Lot of risk, and no guarantee it will help or slow down things. My life changed forever, for the worse, from agreeing to SRT nearly 9 years ago, I suffer deeply from that decision every day of my life, in many terrible ways. And for all my troubles and suffering, my PSA to this day has happily continued to climb. If only I could go back in time.

To echo what Purgatory and Island Time have said, don't do it if you don't have to. Radiation can and does have serious and lasting SE's. In my case, adverse pathology was found upon RP that was previously undetected by MRI or biopsy. Adjuvant radiation was recommended within six months due to SVI. Real life complications such as continence issues and wife's lymphoma and chemo right around when I was to start ART delayed it for a year, while dental problems and antibiotics as soon as I started RT caused many bowel problems that have persisted even today.

I'd guess that the dividing line between T3a and T3b is probably where one would decide for or against RT. You have had the advantage of close medical monitoring over the years (I had none). Apparently there's nothing that would sway you towards definite intervention. I'd suggest you keep it that way until something definitive appears.

Lots of guys here live with mets, lymphatic involvement, and lifelong ADT. Whether there had been a time when ART or SRT could have changed that is difficult to say. One thing that is troubling is that there are guys here who experienced BCR 4-8 years post RP and/or RT. You can't really predict it. And a few years on HT means the window for possible recurrence just gets pushed back. So while I've done everything practically possible, there's still a chance that my PSA could begin to rise a few years after the Lupron has worn off.

In the meantime, I live with leakage and colitis. Yet I do not regret anything other than the timing of what happened when, and of course, that's something we can't change.