Seems like there have been a number of threads asking about
the next steps when primary treatment fails. I'm posting a very informative ASCO publication from 2018. It basically affirms what my MO has always told me: nobody knows if it's better to start systemic treatment earlier or later. The definitive criteria mirrors exactly those of my MO - the presence of any of these conditions:
- PSA doubling of less than 9 months.
- Visible mets on some type of scan.
- Physical symptoms.
MOs deal with the uncertainty for initiating treatment by weighing QOL and their feeling for the risk level of the patient's cancer. I guess this where intuition and experience come into play for the MO. I think a patient's comfort level for knowing they have an increasing PSA is also a factor.
Interestingly, they do not recommend ADT for salvage radiation starting at PSA less than 0.5. They also talk about
intermittent ADT but my head was spinning by the time I got to that part.https://ascopubs.org/doi/full/10.1200/edbk_200319
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: 64.13
2019, March: Lupron/Xtandi, PSA: 1 month: 0.126; 3 months: 0.036; 6 months: <0.02