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At what PSA do you initiate ADT for a biochemical recurrence after prostate radiotherapy (adjuvant, salvage, or definitive)?
Does PSADT play a factor in your decision-making? If so, how specifically?
I've tended to wait until the PSA is 10-15, re-image, and then begin ADT if no overt metastatic disease. The NCCN Guidelines say, "Observation involves monitoring the course of disease with the expectation to deliver palliative therapy for the development of symptoms or change in exam or PSA levels that suggest symptoms are imminent."
Answer from: Radiation Oncologist at Academic Institution
Great question, and one that highlights the variablity in practice and philosophy that often emerges to fill the void when hard data and concrete guidelines are lacking. I find that the PSA doubling-time (DT) often tracks with patient and provider anxiety levels; a rapid DT (<8-10 mos or so) in a...
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