Good to hear from you again, Dominic.  It's been almost a year.  I sure wish
you had come back with some good news.  Dammit!!

To answer your question, "no."  There is nothing other than hormone therapy
as the next step, or at least nothing that is universally or widely
accepted.  There are a few doctors who, in your circumstance, are hitting it
fast and hard with various combinations of chemo and ADT.

I certainly see that as a legitimate attempt at killing the bastard for
someone who had positive margins and Gleason 8 cancer.  If you accept the
theory that ADT is a stop-gap measure to prolong one's life for several
years, then it is often a decision as to whether you want to suffer the side
effects of ADT or the side effects of raging cancer.  But, if you're
squarely in the bastard's sights with T4 / Gleason 8, 9 or 10 cancer,
especially if your PSA is still measure in tenths, then I think an agressive
approach just might be the ticket.

You will not need your rad onc, however.  You will need a general
oncologist.  Your radiation days are over, save for a few treatments for
paliative treatment if and when tumors are noted in areas on whcih the
radiation and be focused.

On August 18, Dominic wrote:

If ADT was previously successful in reducing PSA, it would seem
reasonable to try it again if/when PSA rises to whatever is selected as
the "trigger point."

As for what to select as "trigger point," I think that that depends upon
the history. Generally, I would recommend from my amateur's viewpoint
that the higher the beginning Gleason, the lower should be the PSA at
which to restart ADT. This would seem to be applicable here.

If the PSA does not react sufficiently to the ADT, I believe that that
would be the time to consider chemotherapy, as the PCa likely would have
become
androgen-independent.

It would be best to discuss this with a *medical* oncologist.
Preferably a med onc who is one of the few who are expert in tx of PCa.

Something that could prove very helpful is to post a Prostate Cancer
Digest on Physician to Patient (P2P), along with questions. A
well-qualified PCa specialist should respond within a few days. See
http://www.prostatepointers.org/mlist/mlist.html

Regards,

Steve J

"We must tailor the treatment to the nature of the disease. We must
listen to the biology."
-- Stephen B. Strum, MD