Post RP PSA Rise: Lupron or Not with RT?

Looks like I have some cancer cells that are still lingering after my RP as my PSA has risen. I want to take action with RT and have talked with several of my Dr's but am unsure about adding the Lupron.

My RO says he would only do ADT when PSA gets to 0.5 and/or if Decipher was high-risk (mine was 0.51 which is smack dab in the middle at interm-risk) as he hasn't seen the benefits in studies with PSA levels below the 0.5.
My Uro (who did my RP) on the other hand, recommended I start a 6-mo Lupron shot soon before the RT and continue that for possibly 2 years. I need to ask her why she chose 6-mo and not 3-mo.

On the Decipher report it states that there was low benefit to adding ADT for interm-risk cases. I'm a little concerned with the potential side effects (esp gyno but am unsure if this is possible with just Lupron) but also just want the best possible results with my treatment.

Appreciate the advice-Thanks

My PSA got to 0.56 and I had a pet scan...they found a few nodules on my lungs.... did biopsy. and was diagnosed stage four... Started ADT when my PSA got to 1.32 Started in May with a one month shot...see my sig. My Psa has gone down to now 0.090 Which my doctor said he likes the response.... He will give me one more shot and CT scan to see what is going on with the nodules. I am believing they will dry up... Then he talking about putting me on 6 month shot. The only side effects is cold sweats.....

PS, welcome to the forum, ModelT

ModelT, welcome the the forum.
3 years after surgery, when my rising PSA hit .08, I decided to pull the trigger on SRT and my dilemma was the same as yours, do I do ADT as well. My RO, a highly respected RO, internationally known, at MSKCC, told me that he recommends 6/months ADT but if I chose to refuse it, he could live with that as long as my PSA does not rise above .1 before I start treatment.
I asked him if He could quantify the increase in a chance for a cure that would result from my agreeing to it, and he said my chance for a cure would rise by about 10%. Obviously very subjective, but based on his experience and knowledge. I chose to do it. It wasn’t fun, but it was manageable.

My pathology was similar to yours. But my PSA was undetectable for 2 years after surgery, and. Had negative final margin, but a positive margin on frozen section intraoperatively.

Everyone is different, and this is a very personal decision. As JNF said, this may be your last chance for a cure, so consider that in making your decision.
I also agree that 2 years of ADT in your decision is overkill.

Hi and Welcome, T. As F8 said, wanting the best possible outcome answers your own question. You can delve into the literature about adding ADT to RT for adjuvant/salvage treatment for those in your risk category (easy to do at Google Scholar or PubMed), but it may be hard to prove that nobody draws benefit.

I do have a question about this in your path report: "Margin positivity in area of EPE-"

There was no EPE, so exactly where was your single, small positive margin located?

Djin

Djin: My positive margin was in the L mid posterior area. Very, very small amounts but was the 4 of the 3+4. My RO and Uro both said that it was microscopic.

JNF: Yep, I think that's probably going to be my plan as well. My first ever PSA was 7.037, then 5.152 and 4.652 prior to biopsy.

As the guys have mentioned you got another good shot at defeating this beast! your a young man throw every thing but the kitchen sink at it!! JMHO but I would be starting ADT immediately for at least 6 months or more and getting the radiation going you got lots of living to do!! This is just based on my experience and others that I was at the Hope Lodge with.

Larry

So one of the things I have noticed about PCa studies is that the average age of folks involved is like 65-70 years old.

You are your low 50’s.

One of the reasons some RO’s dont like ADT with low psa’s after rp is because in that older population the adt didnt have much of a benefit and may have actually increased all cause morbidity because of its side effects.

However you are 52 with lots of life.

My RO was a strong proponent of at least a 6 month course of ADT and that is what I did. I am at the end of that treatment now.

With PCa offense is better than defense. Go with the ADT and be prepared to start an exercise program to combat the fatigue.

Glad you have a plan. I think you're making a good decision. Let us know how things go.

Good luck!

Thanks AZ. That's my plan as well. I like your post-SRT/ADT PSA numbers. I'm sure you do too!

At 53 you’re far from being an Old Ford. With hopefully a long life in front of you I would get the ADT/RT along with a gym membership. Although I have no experience with ADT a number of guys on this forum and the gym I go to say aggressive exercise significantly reduces the side effects. I’d be willing to fight for a cure.

Just to add one more experience, Model T, local RO said do nothing when post RP psa rose to .14 at twelve weeks; Boris Mychalczak at MSKCC said jump on it early, so 6-month Lupron shot and 40 radiation treatments. Two years later psa is <.01.

Good to see so many of you continuing to support others, as you did me!

Djin,
Psa was .10 six weeks after surgery. Surgeon said nothing about salvage — one of the reviews of him said he didn’t deal well with “failure.” Very experienced — more than 2500 prostatectomies — and very good until the psa persisted. He said only come back in 6 weeks, which I did, and psa had risen to .11. Although I had the psa check then, surgeon cancelled that appointment with no explanation or instruction so I moved on, disappointed with the surgeon’s apparent disinterest.
The RO who suggested doing nothing is a local guy, general not prostate-specific, at a small regional hospital in Cooperstown, and he was not as knowledgeable about persistent PC as the docs quoted by others on healingwell. He thought waiting until the psa was much higher - 2.0 or more — would be OK. Healing time was not an issue because the radiation wouldn’t begin until after scans to rule out mets and also 3 months after the Lupron, meaning radiation would start 8+ months after surgery.
Meanwhile, I had discussed radiation rather than surgery with Dr.Mychalczak at MSKCC before opting for surgery, and he had followed up to see how I was doing, so it seemed natural to go back to him, and I Am glad I did. Professional, caring, on top of the research.