My PSA is 5.3, Gleason (3+4) 7 and Decipher .61. Do I need ADT?

Hi. Welcome to our community. I’m a layperson, not a doctor so any comments I share are solely based upon my personal experience and not medical advice.

ADT (and radiation) isn’t typically included in the standard of care for favorable Gleason 7. If you have RP and the pathology shows more serious disease, extracapular extension, positive margin, or seminal involvement, your surgeon might want to include ADT and possibly RT.

Best wishes for good health and a successful journey with PCa.

okiedokie555,
ADT stops the tumor from growing, and often shrinks the tumor. Because you are intermediate decipher, I suspect your medical provider will recommend it. ADT does increase the %age of men who survive and the %age of those who survive metastasis free.
It had been considered that two month before treatment was ideal. But the thinking seems to be shifting as not much advantage is seen for pretreatment ADT. The advantage is during and after even in low risk patients. https://www.youtube.com/watch?v=Fop3b61o2qw The ADT results are about 3/4 of the way into the video.
If you have large tumor(s) or if they are near nerve bundles, it may be additionally advantageous to protect the lower nervous system . It' s a tough decision.
If you do decide to take it, consider the pill orgovyx instead of the injection. And check into low dose Cialis. Cialis is thought by some to protect the blood supply to the nerves and thereby protect the nerves during treatment. Bless you choice.

How many cores were positive and volume %? Without more information it would be difficult for us total amateurs to make an assessment.

With the limited info given, ADT would be the last thing on my mind. AS seems the logical choice.

Did you get any additional opinions?
As a lemon and if it were me, an intermediate decipher test score would probably lean me towards the same decision that I made which was to use the Mridian narrow margin built in Mri radiation machine. one radiation oncologist suggested active surveillance, and the rest did not. I had a 3+4 Gleason, a low risk decipher score but a PSA that was 10.2 which nccn.org would suggest ADT. One radiation oncologist did suggest that. if you can get multiple opinions from other doctors, you might want to do that as whatever decision you make you want to try and be as comfortable as possible with accepting it.
My side effects are minimal and I had 5 hypo fractional treatments finished in February 2023.
Please feel free to private message me if you want additional information. Good luck with all of this and take one day at a time. it is a process.

I had a PSA of 4.63, two cores with Gleason 3+4, and a Decipher score of 0.84. The recommendation in my Decipher report was for multi-modal treatment which meant ADT should be included. But my RO was adamant that ADT was unnecessary and possibly detrimental. I’m about 10 months removed from my VMRT treatments without ADT and my PSA continues to trend downward (0.79 in March).

What is your age and do you have PSA history? So many options exist now, but need some additional information to help the baseline. Thank you and stay positive.

I can't offer an opinion because there are too many factors to consider, e.g., age, overall health, priorities (quality of life vs. longevity), etc. I do suggest you view a youtube video of a 9/13/19 lecture by Dr. John Mulhall about uncertain T recovery after ADT during which he talks about what a patient is getting into with ADT and what "they" (urologists and ROs) often don't explain to the patient. My #s at diagnosis were 4.2, 7(3+4), and Decipher .71, and my RO recommended a 6 month course of Orgovyx, after only a superficial reference to potential side effects. After struggling with the decision, I opted to take the drug. While Orgovyx may be better than other drugs, I experienced debilitating side-effects including dizziness and imbalance while standing, brain fog and fatigue. Finally, one year after my last dose of Orgovyx, those symptoms seem to be subsiding, and my T is recovering to a near normal range. Orgovyx literature touts rapid T recovery, but only for 54% of patients, and your odds are worse if your T baseline is not above 400. Good luck with what I appreciate is a difficult decision.

Just remember there are two options for ADT.
One is chemical, the other is surgical. Read all you can.
Cancer.gov also has good info.

i love my Mayo team!!!

Well, the limited clinical data you provided makes it challenging for the forum to provide you their insights, experience and thoughts based on their experiences.

Starting point would be reading through the science. One would be the NCCN Guidelines:

Early stage - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=49

Advanced stage - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=50

There are others, the American Urology Association - https://www.auanet.org/guidelines-and-quality/guidelines/oncology-guidelines/prostate-cancer

The Prostate Cancer Foundation has resources too - https://www.pcf.org/

The good news, you have choices, that's the "bad" news too. There is nobody who can rightfully give you a definitive answer as to what to do.

I would first inform myself by reading the literature, I've given you a few to start. Doing that inform you and raises the quality of discussion with your medical team. This supports several of my rules for myself as a patient:

Don’t Walk In Cold to an Appointment. To make sure I do the best thing for my individual prostate cancer, I need to educate myself.
Walk in the door ready to start the conversation at different level. I don’t have to spend time talking about the basics, things like Gleason grade and clinical stage and what they mean. I already know. I can have an intelligent discussion about the merits of a particularly treatment for my cancer, my likelihood of being cured, and risk of side effects.

Now begins the art, applying the science to your treatment decision based on your clinical data

Then i would consult with each and every member of a multi-disciplinary team - urologist, radiologist, and oncologist. Each should have expertise in prostate cancer.

If you have had imaging, such as one of the newer PSMA tests and some degree of assurance that your prostate cancer ha not spread to the lymph nodes, bones, organs, surgery may be an option, that involves choices to, robotic, single port or multi-port, or the old fashioned way. Radiation may be an option too in localized PCa, lots of choices there too.

You could do doublet or triplet therapy, ADT (which drug, Lupron, Orgovyx, Casodex, Firmagon...) plus an ARI, again which one and for how long. Do you add chemotherapy, typically not if local only. Do you do ADT, ARI and radiation therapy, maybe.

Ok, I'll stop here.

My takeaway, you have work to do to inform yourself of the science behind treatment decisions, consult with your medical team, then make a decision in concert with their recommendations and your personal preferences and yes, insurance. It's a delicate balancing act, blending the science which is supported by levels of evidence albeit which is population based data and historical with the art, application of the science to your PCa and data coming out of clinical trials, particularly Phase 3.

Much has changed since my diagnosis in 2014, imaging, ARIs, genomic testing, HIFU, PSMA imaging, making for a number of tools to use by the patient and his medical team. As an example, when my PSA started rising last year, we imaged when my PSA hit .7 (our decision criteria was between .5-1.0), the scan showed a single PLN. When I met with my radiologist (the same one who did the SRT in Jan 16, we agreed that back in the day, we would not be having this conversation since imaging would not have been possible at that low of a PSA.

More and more, mainstream clinical practice is to:

Use combination, not mono-therapies.
Combine and bring treatment forward in the disease when they can be more effective.
Treat for specific periods of time.

Kevin

I'm 61 yrs. old and had to make the nearly identical decision , I had similar #: PSA-5.3, MRI idetified the tumors and the biopsy results were 3x Gleason 6 cores, 3x Gleason 7 (3+4) favorable Intermediate cores. Results from MyRisk Hereditary cancer test for BRCA1 & BRCA2 were negative. My Dad currently 89, had prostate cancer in 2006 and did RT with ADT back then. His treatments went well and his side effects were minimal, fatigue along with the major one being more frequent urination. About 3 years ago his PSA was increasing and his urologist gave him injections of Orogvyx (I think?). My paternal grandfather, died from PCa in 1988, very different times in terms of PCa diagnosis and limited treatment options. Fortunately I have the benefit of family history since along with recent medical advances which helped me make my decision- IMRT with NO ADT, starting in the next few weeks. I had consultations with 2 different Rad. Oncologists- one at UNC Chapel Hill, the other at UNC Rex, both here in North Carolina. Both said same, no need for ADT with my diagnosis and the pathology of the cancer cells .
What reinforced my decision was this recent study which I learned about from pcri.org
https://www.youtube.com/watch?v=cyY0nHXvzGc:
The need for androgen deprivation therapy in patients with intermediate-risk prostate cancer treated with dose-escalated external beam radiation therapy https://pubmed.ncbi.nlm.nih.gov/28263132/

What did not sit well with me was that my Urologist recommended the need for 6 months of ADT on numerous occasions, but did say he would consult with the Radiation Oncologist. Same guy was also heavily pushing for RP surgery when I was given diagnosis in early 2024. I know why, $$ . When I brought up the recent study to him, his response was" well I do not read all of those" . When I told him of my decision to go with IMRT he said "see you in 6 months to check PSA" even though the radiation oncologist had contacted him about implanting the gold seed markers for the RT . Probably going to switch urologists in the near future because I also had other issues with his office team and their ability to give me accurate information.

I have heavily leaned toward quality of life impacts in making my treatment decisions based on my age, family experiences with PCa and being fortunate to have very minor medical needs impacting my life currently. One more recent event to share, that really sucks, which I believe impacted my Dad was the side effect of ADT, brittle bones. At 88 years old he tripped and fractured his hip, but, I'll never know that for sure if it was related. Everything I have read about the side effects of ADT and how it would probably change my quality of life based on my diagnosis- no thanks.