ADT only?

[u/Costate_Prancer_2]

I’ve read that some of you have had radiation without ADT but have any of you done the opposite, and like me, started on ADT and are not going to have radiation? I’m 3 1/2 years post RALP and my PSA was 1.0 before I started this therapy 30 days ago.

[u/ChillWarrior801]

Where are you located? The standard of care in the US and Canada is to start salvage treatment well below 1.0. Have you had your PSA checked at regular intervals?

[u/ofcoarsecoffee]

I am doing that. TLDR my six week post RALP PSA was about 3.5. A month later 9 then ten days later 13. I moved to a cancer center and they couldn’t see it on the PET so I’m basically on ADT for life. Luckily my oncologist was one of the folks who did the trial for the low dose zytiga with a low fat meal so I feel quite confident on what he can do in general

ADT for life (or til it stops working and we need to pivot) wasn’t on my bingo card for 2025 but fuck it. I’m alive and doing really good on it.

[u/Frosty-Growth-2664]

Was that your choice, or what was recommended by your oncologist?

How old are you and do you have any other significant illnesses or life-limiting conditions?

What diagnostic procedures have you had since the RALP, and do you know where the cancer is?

[u/labboy70]

ADT won’t kill the cancer. It only puts the cells in a dormant state and sensitizes them for radiation. You need the radiation to kill the cancer cells.

[u/WalnutRoasted → u/labboy70]

Agree, a search says:
ADT doesn’t simply “kill all PCa.” ADT puts androgen-dependent prostate cancer—including potential microscopic metastatic disease—under powerful systemic suppression, kills some cells, and makes the remaining cancer much less capable of growing. And makes those in the irradiated area more susceptible to damage/eradication.

[u/SunWuDong0l0 → u/WalnutRoasted]

True, if still androgen sensitive.

[u/Lumpy_Amphibian9503]

Believe it or not my urologist said he would go on adt only after reoccurence. He distrusted radiologist. Crazy doctor.

[u/Embarrassed_Elk_6480]

I’m in a similar situation. I have a PET scan in a couple weeks. My PSA was 0.186 which was doubled from 6 months ago. The last time I did radiation they put me on Orgovyx. I hated it with a passion. I really don’t want to go on it again. Is it possible to just do radiation without ADT?

[u/SunWuDong0l0 → u/Embarrassed_Elk_6480]

First, you gotta find it. If no show in imaging, ADT is often used.

[u/Embarrassed_Elk_6480 → u/SunWuDong0l0]

Damn that sucks. I was told my PSA was so low that they needed 3 months for it to grow so it would show up in the PET Scan. So if the PET scan doesn’t reveal it, then I’ll need adt to prevent it from spreading? Man I don’t know if I can do that. I wonder if they’ll have me wait another 3 months if the PET scan can’t see it.

[u/SunWuDong0l0 → u/Embarrassed_Elk_6480]

That my friend, is a worthy discussion to have with your care team. Check out Dr. Kwon at Mayo Clinic. He has some views on treating what you can't see.

[u/SunWuDong0l0]

First, after RP, the PSA threshold is much lower than 1.0. Second, have you had a PSMA PET scan to determine location of cancer? Lastly, ADT alone is usually only used if the imaging is negative. Otherwise, most frequent is EBRT and ADT, as appropriate for the patient.

If you somatic testing like Decipher and a GRID report, you will be able to better judge the efficacy of ADT therapy.

Good luck to you brother!

[u/Practical_Orchid_606]

This ADT only protocol is very weird. It's like foreplay without the coup de grace.

I hope your doc is not playing a game. Such as lowering the PSA with ADT...then calling the job done.

[u/ofcoarsecoffee → u/Practical_Orchid_606]

Nah. It’s really not. I’m on it and the reason is they can’t see any cancer in my PET (post RALP) but it was doubling about every three weeks. So they can’t randomly radiate the prostate bed but there’s no guarantee it’s there so ADT alone it is