When to start ADT?

Couple of questions seeking advice. I was a G8 at time of Dx so not surprised that surgery failed, SRT failed, and now I have what I believe to be a rapidly rising PSA. I get tested monthly and for the past several months it has been rising about a tenth of a point each month. I’m now at 0.6 and my Uro is telling me I should start ADT even though he previously told me to hold off until my PSA got to like 10 or 15. Now he says that’s true for patients with slowly rising PSA but with my current velocity the game changes. So for those of you who have experienced a similar situation, when is the right time to start? I know this is a time limited treatment to slow progression and can’t say I’m excited about the prospect of side effects and would hate to pull that trigger too soon....or too late.

I also discussed the possibility of using Zytiga or Xandi with ADT but he isn’t a fan of that. I blanked out at the name of the study I had read and was trying to tell him about (Stampede) but wouldn’t it be wiser to go that route given my history, PSA velocity, likely aggressive PCa with the hope that both together would give me a better chance of CR longer than ADT alone? Long story short, my Uro basically fired me after that discussion indicating that he can’t meet my expectations for treatment since they only deal with this one way...ADT alone. Other than that option, he suggested I go elsewhere if I want “experimental” treatment.

I also have an MO in the wings but he usually deals with guys whose ADT has already failed, although he is aware of the Stampede study and we have discussed the pros and cons of the various options. Last we met, the MO was not recommending that I start treatment yet but wants me to make the call as to when to start.

So, I am very uncertain as to what to do and when? Any advice would be most welcome. My stats are in my sig if that helps any.
Thank you,
Bob R.

You need to find an MO who has lots of experience working with PCa patients at all levels of treatment not just after they become castrate resistant. At your point in treatment, and my own, treatment choices are as much art as science and need the judgment of an MO who deals with PCa patients who are at all stages, who is up to date on latest treatments, and who is tuned in to clinical trials. Where do you live? Do you have access to a major top-tier cancer center - MDA, Mayo, Cleveland Clinic, Dana-Farber, Sloan-Kettering, etc.? When my PSA returned after failed SRT I moved my care from my local RO to an MO Dana-Farber in Boston, which for me is just 40 miles away. But I've met patients there who come in from much further away than I do. Even if you have to travel to a major treatment center, you may be able to arrange a consulting relationship between their MO and a local MO if frequent visits to a leading medical center if frequent visits aren't practical.

I just spent a year on monthly Degarelix shots at Dana-Farber. I'm now on break from shots and have monthly blood tests done at my local hospital with results forwarded to D-F.

Jim

You are making this more difficult and complicated than it is..In the end, what you are doing now won't make that much difference..One of the new Ga-PSMA scans might pinpoint your tumor location which can be treated with spot radiation, but again, in the end, the result is the same...

Every day there are amazing new treatments coming online which could turn out to be a game-changer for all of us..