Finished IMRT, now what?

congrats Reb on completing your RT. There is Absolutely the ability to have surgery after Radiation and it is becoming more common. Steve1961 on this site just completed salvage surgery. It’s true most surgeons don’t do, but at the major cancer centers you can usually find surgeons that have an expertise in it and are successful.

Did they do a PET scan? I think you are in the same boat as most people when it comes to knowing if treatment worked. They just keep checking PSA to see if its rising. Right now while on ADT you won't really know unless it starts climbing. Also, I didn't think they do surgery once PCa is outside the prostate. Press your doctors on all your options. Hopefully you won't need them.

Were you prescribed Prednisone along with Zytiga? They are usually prescribed together, as Prednisone will minimize/stop any negative impact to the liver and kidneys. I spent 2 years on Lupron/Zytiga/Prednisone cocktail for 2 years, with my PSA and liver/kidney blood draws every 3 months, and my bloodwork always came back as within acceptable limits.

And yes, results from Europe (less regulation and quicker drug approvals) show that this 3 component cocktail along with targeted radiation has been very effective in treating recurrences, much more effective than radiation alone.

Whatever further treatment that might be needed, proton or otherwise, depends on how and where a recurrence is. They have to have a target for proton or other radiation, not just a rising PSA number. It seems to me that the doctors cant make any definite statements without knowing if and where it may show up. Yeah, it's tough being in that wait and see mode.

Unfortunately, nobody can give you a clear picture on where you will be in the future as related to your prostate cancer (PCa), as all cases are different (even if only a little different). Based on what you have said, and adding to my previous reply to you, in my non-medical opinion, you are on the best available path at the present time.

If you PCa recurs at some point in the future, the location of the lesion will determine what type of additional treatments will be available to you. If the lesion is found to be in a radiation-treatable place through a PSMA scan, you may be offered SBRT radiation, which is targeted high dose radiation, delivered in 3 to 5 sessions. IMO, SBRT is a nothing burger, not at all like the potential side effects associated with IMRT.

Like myself, you will probably tested every 3 months for PSA, and periodically for Testosterone levels. As long as the PSA is undetectable or stable and low, you will get a reprieve for the next 3 months. While this may not seem like an optimal life setting going forward, if you adjust your mental attitude to accept this new way of life, you will find that you can still achieve much more than an acceptable quality of life.

If you look at the BIG picture, PCa is one of the better types of cancer that you can have (bitter irony, I know). You could have had pancreatic cancer or brain cancer, or some other type of cancer where your life expectancy is measured in months or only a few years.

Live your life one day at a time on your PCa journey, in between the periodic 3 month PSA tests. I wish you the best of outcomes on your PCa journey.

Your diagnosis and treatment plan are very similar to what I went through. PSA 30 Gleason 9 Pet scan was negative however…so no spread to lymph nodes for me. Had the "Triple" treatment of HDR Brachy, 25 session external and ADT with Zytiga also. My final PSA when I stopped all treatment was 0.01. I had 3 years of ADT with a shot monthly. Started with the Zytiga 1 year into the ADT, so I had that for 2 years. My liver numbers never were a factor. I got lucky there also. I took 1 5mg prednisone a day .I was diagnosed in April of 2020. I am 65 years young now so I was just 61 then.

One thing you need to remember is that your PSA will go up after you stop treatment. My last two tests were 0.34 and 0.33. My radiologist says that is perfectly normal numbers with me still having my prostate.

Good luck and keep your head up. One day at a time. One PSA test at a time.

so hard to read these comments has the wife of a prostate cancer patient, clearly I cannot know exactly what your going thru physically which is frustrating in being there for my husband. He is in his 3rd yr of treatment prednisone and Zytiga. Hormone suppressant injection every 3 mos. The treatment is really hard dizziness, cognitive decline on difficult days some nausea and headaches. Extreme fatigue and with prednisone extreme weight gain. It’s hard being he cannot drive anymore. This was a shock because his routine yearly prostate exam showed a relatively low number urologist suggested a watch and see but left it to us to do a biopsy. What made my husband decide to get additional testing (early diagnosis) is likely why he is here now. I will not forget the doctors words “time is not on your side” and aggressive treatment started immediately. He has one tumors on ea side of his thigh bone another on his lower spine. Stage 4 Mets, how could this happen without side effects all this time? Yes his side treatment/side effects are brutal I keep pushing him to get palliative care this is a battle for him to except. But to you all I say don’t give up. Here is some positive I want to give to all of you in this difficult time, my husbands tumors on his thighs are no longer visible on his scans this treatment is WORKING his psa is practically zero his numbers are good no ill effects to organs he is struggling some with hypoglycemia his sugar will drop sometimes he manages with food. He has his regular 3 mo ck in with oncologist and I hope he will try to resume palliative care, don’t be afraid to ask for help this will not be easy don’t try to think too far ahead you all still have lives to live and the medical advancements are happening all the time.