There's another thread already going about
when to start ADT after failed RP/SRT. I've copied my post from that thread to here. It's basically a question of starting earlier or later. Different patients and different MOs have different comfort levels with an increasing PSA.
Lupron + Zytiga or Xtandi or chemo is the current paradigm.
You're in the murky area of your treatment path now, with no clear standards. I've had three MOs now who advised me the ideal time to start ADT is just prior to physical symptoms, but no one can predict that point, so a more conservative approach must be used. Some MOs may be much more conservative. Definite independent triggers are:
- High PSA velocity
- Mets visible on CT or bone scans
- physical symptoms
Note that the definition of visible mets is changing with the advent of more sesnsitive scans.
I pushed my PSA pretty high thinking there is a limited clock with ADT, which my MO endorsed. I chose Xtandi to avoid the Prednisone and meal restrictions that go with Zytiga.
2015 (Age 54) PSA: 20.8
Bx: All cores G7 (4+3)
RALP & Adjuvant RT
Pathology: G8 (4+4)+5
PSA nadir: 0.1, steady increase until 2019: 64
2019, March: Lupron/Xtandi, PSA: 0.036
Post Edited (mattam) : 7/29/2019 1:13:06 PM (GMT-6)