RADICALS-RT Study

I had a robotic RP about two months ago and have been discussing additional treatment with my three oncologists (surgical, medical, and radiation). The RADICALS-RT study that was reported at ESMO a few weeks ago has started a bit of a debate. That study has shown no advantage to adjuvant radiation/ADT versus early salvage treatment. One of my doctors now says don't do any adjuvant treatment, one says he's not opposed to watching/waiting at this point, and one says absolutely do adjuvant radiation/ADT. What's driving the doctor who wants me to continue with immediate adjuvant treatment is that although my Gleason score wasn't horrible (3+4=7), post-surgical pathology showed involvement in 2 lymph nodes (out of more than 40 removed).

So, I'm wondering -- even though the presentation on RADICALS-RT was just a few weeks ago, has anyone been getting any feedback from their doctors on it? If so, what are they saying?

Thanks

9/18 - PSA 10.4, DRE negative (Age 53)
3/19 - PSA 10.9, Free PSA 0.9 (Age 54)
3/19 - MRI positive / PI-RADS 5 / Transition Zone
6/19 - MRI-guided biopsy positive, Gleason 3+4=7, 3/3 cores positive
8/19 - Robotic RP w/extended lymph node dissection
- pathology showed bladder neck involvement, both seminal vesicles involved, 2 lymph nodes positive, all margins negative
10/19 - PSA undetectable (<0.03)

Two items to consider - obtain 2nd opinion on prostate surgery pathology, obtain Decipher genomic test on prostate tumor tissue. Urologist should be able to arrange this for you. This will give you more data to make decisions on. You have complicating factors with SV, bladder neck, and lymph node involvement so you need to beat those to death with the doctors. The rest sounds like waiting.

Welcome to HW, sorry you need to be here.

"- pathology showed bladder neck involvement, both seminal vesicles involved, 2 lymph nodes positive, all margins negative"

That would drive the recommendation for ART. It's a tough call. The low PSA reading suggests they got it all while the lymph node involvement is concerning. It's really up to you. You could test again in another month and see. In any case, if you did go with ART, it would take a few weeks to get the schedule, scans, etc setup.

In regards to radiation, I wouldn't take advice from a surgeon.

Andrew