Dr. Todd Morgan

But if you look at the data, they're probably not as bad as we think in our heads as urologists that There's a pretty robust set of data, including from University of Chicago, who's looked at there's a series of patients undergoing salvage radiation. And a lot of the side effects are relatively short-term, and late effects are pretty mild. So I think we think about all those things.

And then so on top of all that, these days, we're going to get a PSMA PET at some point. And maybe we're going to get it at the six-week mark. We're going to confirm the PSA and then get it probably typically, but we're certainly going to get a PSMA PET sometime in the vicinity of when we confirm that PSA recurrence.

And then so on top of all that, these days, we're going to get a PSMA PET at some point. And maybe we're going to get it at the six-week mark. We're going to confirm the PSA and then get it probably typically, but we're certainly going to get a PSMA PET sometime in the vicinity of when we confirm that PSA recurrence.

And then so on top of all that, these days, we're going to get a PSMA PET at some point. And maybe we're going to get it at the six-week mark. We're going to confirm the PSA and then get it probably typically, but we're certainly going to get a PSMA PET sometime in the vicinity of when we confirm that PSA recurrence.

So that's a great comment. It's something that was not on my radar prior to the guideline process. And it was Brian Chapin who said just what you said. He said, oh, I find MRI really useful in this setting. And we looked at the data and we had, you know, discussed it with our radiology colleague on the guidelines.

So that's a great comment. It's something that was not on my radar prior to the guideline process. And it was Brian Chapin who said just what you said. He said, oh, I find MRI really useful in this setting. And we looked at the data and we had, you know, discussed it with our radiology colleague on the guidelines.

So that's a great comment. It's something that was not on my radar prior to the guideline process. And it was Brian Chapin who said just what you said. He said, oh, I find MRI really useful in this setting. And we looked at the data and we had, you know, discussed it with our radiology colleague on the guidelines.

And at the end of the day, that is included as a, forget the exact language, but you may consider an MRI as well in this setting. And so I've been, I've started using it in some patients and it is interesting. Certainly, MRI can pick up some local recurrences that just get washed out by the tracer in the bladder, in the urine.

And at the end of the day, that is included as a, forget the exact language, but you may consider an MRI as well in this setting. And so I've been, I've started using it in some patients and it is interesting. Certainly, MRI can pick up some local recurrences that just get washed out by the tracer in the bladder, in the urine.

And at the end of the day, that is included as a, forget the exact language, but you may consider an MRI as well in this setting. And so I've been, I've started using it in some patients and it is interesting. Certainly, MRI can pick up some local recurrences that just get washed out by the tracer in the bladder, in the urine.

Well, that's where hormones really saves the day, I think. Because these patients who have high-risk disease, who have earlier recurrence, shorter doubling time, they're going to need ADT with their RT. And so that really can provide a bridge. And we absolutely use that. Just very broadly, we usually say, okay, we're going to think about radiation around the six-month mark. Yeah, some patients...

Well, that's where hormones really saves the day, I think. Because these patients who have high-risk disease, who have earlier recurrence, shorter doubling time, they're going to need ADT with their RT. And so that really can provide a bridge. And we absolutely use that. Just very broadly, we usually say, okay, we're going to think about radiation around the six-month mark. Yeah, some patients...

Well, that's where hormones really saves the day, I think. Because these patients who have high-risk disease, who have earlier recurrence, shorter doubling time, they're going to need ADT with their RT. And so that really can provide a bridge. And we absolutely use that. Just very broadly, we usually say, okay, we're going to think about radiation around the six-month mark. Yeah, some patients...

have a really quick recovery. We feel comfortable with radiation at three or four months. But in principle, we're kind of thinking the six month mark is the right timing for most patients. But we can start ADT at three months. We can start it at four months. We can start it at two months. If we were at this patient, if they have a PSA of

have a really quick recovery. We feel comfortable with radiation at three or four months. But in principle, we're kind of thinking the six month mark is the right timing for most patients. But we can start ADT at three months. We can start it at four months. We can start it at two months. If we were at this patient, if they have a PSA of

have a really quick recovery. We feel comfortable with radiation at three or four months. But in principle, we're kind of thinking the six month mark is the right timing for most patients. But we can start ADT at three months. We can start it at four months. We can start it at two months. If we were at this patient, if they have a PSA of

one or two, and they're really at higher risk of recurrence. So that helps. Because then we get started ADT, that lowers anxiety quite a bit. PSA goes down to zero. And I think that buys time to give safe radiation that balances the oncological benefit with toxicity.

one or two, and they're really at higher risk of recurrence. So that helps. Because then we get started ADT, that lowers anxiety quite a bit. PSA goes down to zero. And I think that buys time to give safe radiation that balances the oncological benefit with toxicity.

one or two, and they're really at higher risk of recurrence. So that helps. Because then we get started ADT, that lowers anxiety quite a bit. PSA goes down to zero. And I think that buys time to give safe radiation that balances the oncological benefit with toxicity.

So it's really sort of the radiation field. Is it just prostate bed or prostate bed plus nodes? And then I guess even prostate bed plus nodes plus or minus metastasis directed therapy if there are a couple other sites of disease seen on PSMA PET. So that's really, that's the radiation piece. And then there's ADT and there's timing of or length of ADT.