At what PSA do you initiate ADT for a biochemical recurrence after prostate radiotherapy (adjuvant, salvage, or definitive)?

Great question, and one that highlights the variability 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 an ...

Unfortunately, this still remains a highly controversial question fraught with many caveats and no clear answer. I like to think of this question in two parts: 1) when do you consider/start systemic therapy for a BCR after radiotherapy (definitive or post-op) and 2) what should the treatment be?

One ...

As a radiation oncologist, when I have a PSA failure, the most important issue I consider is to restage the patient with PSMA PET/CT to determine the extent of relapse and assess if the patient can be salvaged with SBRT.