I think you should consider approaching tis in exactly the same way that a man with a GS 6 approaches active surveillance..
The most likely scenario is that there was a tiny bit of GS 6 left behind. Most of the time, GS 6 never
progresses to anything more than that. It is probably something that you can safely watch for a lifetime and never need to treat. Here's an article about
The main difference is that you can't biopsy to track progression. But you can monitor PSA, and maybe take an mpMRI every few years. If your PSA rises above 0.2, one of the new PET scans may be able to locate the site of failure.
There was a randomized clinical trial (RTOG 9601) of SRT with or without adjuvant ADT. They reported: "those patients most likely to benefit from the addition of AAT included men with adverse prognostic features—namely, those with Gleason scores ranging from 7 to 10, entry PSA values of 0.7 to 4.0 ng/mL, or positive surgical margins. In contrast, little difference emerged between RT plus AAT versus RT alone in those with a Gleason score of 2 to 6, an entry PSA level less than 0.7 ng/mL, or negative surgical margins.
So you are NOT in a category that would benefit from adjuvant ADT.
Paul Nguyen had published a small retrospective study with somewhat conflicting findings. When I asked him about
Paul Nguyen said...
Dear Allen, Great question.You are right. Our study was a small retrospective study while the rtog 96-01 was a large randomized phase iii and so our finding was not concordant with the randomized trial and I would trust the randomized data more. However it is not necessarily the case that we can definitively say that patients with negative margins do not benefit. I would say that if a patient had high risk Gleason 8,9, or 10 and had T3 Disease and a rising Psa I would still give adt even if the margins were negative
I know Howard Sandler (principal investigator of RTOG 9601) does not give adjuvant ADT with SRT unless PSA=0.5 (ROs will have different thresholds for adjuvant ADT).
But it looks like, whichever way you cut it, you would not be a candidate for adjuvant ADT at a PSA of 0.1, according to your own doctor.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog