What's Next....Post RP; Salvage radiation & ADT?

Dave,
Your tumor load, positive lymph nodes, and upgrade to G9 can make things difficult going forward. I think the two years of ADT is good choice given the circumstances.

I think "cure" is sometimes a reluctant word around here, but yes that possibility does exist for you. Unfortunately, another possibility is that cancer has escaped even though the scans don't show anything. Either way, you have a long road ahead of PSA tests, ect. You're just going to have to be patient and see where things go.

Not wanting to paint a picture of gloom, because you do have a long ways of life ahead of you -- but there will be adjustments.

Dave...even though I didn't have surgery as my initial treatment, I think there are similarities in our situation. I was also a G9 and diagnosed at age 51. I had the brachy/EBRT/ADT combo, so in some ways the only difference in treatments was the initial treatment of surgery vs brachy. Like you, the EBRT was to the area surrounding the prostate and the lymph nodes. My ADT was for 18 months.

So while our situations aren't a perfect comparison they do share similarities and I'm doing fine almost 10 years after diagnosis and about 8.5 years after finishing ADT, with a PSA that has been low and stable. To answer your question as to if I think I'm cured, my thinking has always been "I'm cured until something happens to prove that wrong." I have PSA checks every 9 months now. I hope you'll have a similar success.

Dave, your Dr is a wise man. His comment "i will assume you are cured until proven otherwise" is a good approach and that is the approach i have taken since my salvage and 6 months of ADT.

As an aside, it has been 3 years and i am undetectable. I have been testing every 6 months, and at my last consult, the NP told me they would be comfortable stretching out to yearly testing. She said its still possbile i could recur (we here all know that, and that will never change) but its not very common after 3 years of undetectables.
I have chosen to stay at every 6 months for now

Hi Dave,

I had a somewhat similar journey. My PSA began going up almost immediately following my RP, which resulted in a 6-month course of Lupron and 39-radiation treatments. While going through the radiation, I wrestled with my odds for success and wound up torturing myself by repeatedly attempting to find the answer to something that cannot be known now. I ran my numbers through nomograms, did tons of Google searches, you name it. Each search provided me with some information, but not specific enough to apply to my individual case. I also came across a lot of negative information, which unsettled me as well. Overall, this was not healthy for me to keep doing.

I finally came to rest with the understanding that I was doing everything I possibly could to treat my cancer including treatments, exercise, diet, lifestyle, etc. And, I did take some solace in the high probability that the cancer wasn't likely getting any worse while on hormones. As a result, I treated the time of waiting as a sort of holiday. While I didn't have a clue whether the radiation worked or not, I also had a high degree of confidence that things likely weren't deteriorating while I was waiting either. Also, my RO said that if I believed the treatments were destined to fail, that there would be other treatment options for me to consider, if I needed them, when the time came. He was basically reminding me not to try and fight some future battle that can't possibly be waged in the present.

In some way, I think we would all like to cross that big bridge to the so-called "cure" place as though there will be one intervention and a single outcome - cure. In reality, through our daily process of taking our treatments, showing up for checkups, diet, exercise, etc., we are crossing lots of little bridges that hopefully help us to extend our lives a little bit at a time, with the hope of some day getting to the place of ultimate cure, if we are fortunate enough.

When I start focusing on the process (something I can control like showing up for all 39 radiation treatments to make sure they all got done) instead of outcomes (something I can't control, like wondering if I'm cured), that's when I am able to stay in a relatively good place. Now, when that question about cure comes into my head (my mind wanting to focus on the big outcome), I shift my thinking to process (what I'm going to do to stay healthy today).

I think you can take comfort that the treatments you have chosen have already extended your timeframe further into the future than if you had done nothing, AND, you have given yourself a real chance at doing a lot better than that.

Sending you good wishes as you navigate through the waiting phase.

Rick
_____________________________

Age - 62
PSA in Oct 20 - 7.2
DaVinci Prostatectomy - 1/27/21
Gleason 7 (3+4), -Margins/-Nodes/-SV; bladder neck invasion; Stage T3a
PSA Mar 21 - 0.05
PSA May 21 - 0.12
PSA July 21 - 0.18
PSA Sept 21 - 0.32

PET Scan in Sept 21 - clean
Salvage Radiation (EBRT) - 39 session; 72GY + 6 month Lupron

PSA Jan 22 - <0.01
PSA Apr 22 <0.01/Testosterone 3
PSA July 22 <0.01/Testosterone 750

Post Edited (Rick I) : 8/11/2022 9:13:10 AM (GMT-7)

Rick I,
Thank you for a very informative response. As I read your post, all I could think about was the exact actions that I have been doing since my diagnosis back in October 2021. It is so true that all I can do is finish my 44 radiation treatments, exercise, eat healthy, complete my 18 months of Lupron, do my blood work and go to my appointments.

Thanks again!

Ron

Dave,
I am another guy who is ten years out from surgery and radiation and eight years out from 24 months of ADT. I've been pretty much undetectable except for one small but detectable PSA result between surgery and the hormones/radiation.
As you said in your posts there just isn't that much you can do about your odds of a recurrence. You probably won't know anything for years. One thing that helped keep me from making myself crazy was to focus on minimizing the side effects from the treatment -- things I could do something about rather than worrying about the long-term prognosis.
John Maynard Keynes was not my favorite economist and he was talking about monetary policy, not medicine, when he wrote "In the long run we are all dead" but the quote has some more-or-less accidental applicability to prostate cancer. The best way to keep from excessive worry about the future is to find ways to keep busy today. Tomorrow is never guaranteed for anyone, cancer or no, and it is sensible to work on today and let tomorrow work itself out. There are a number of things that can improve your quality of life while you are on ADT. Exercise is important. Now that you are finishing your radiation you will probably feel less fatigued and exercise will help keep your energy level up. If you aren't a member of a gym join one, and if you already are a member, don't forget to go. Another thing that helps is telling your doctors about problems that are limiting you. There are drugs that help with ADT-related brain fog and the depression that thinking about that next 18 months of hormone shots tends to cause.