@tango32652

My COT, course of treatment, was going to be ADT, specifically Eligard, for 6 months paired with 25 fractions, med speak for sessions, of Proton Therapy to treat my Gleason 4+5, cT3bN1M0, NCCN Very High Risk prostate cancer. However, the RO, Radiation Oncologist, decided the volume of tumor cells in my prostate and pelvic region plus the proximity of some tumors to vital organs such as the rectum and bladder precluded Proton Therapy for the present. Thus the MO, Medical Oncologist, switched my COT from Eligard + Proton to Eligard + Erleada + Wait and See for 4 to 6 months with periodic diagnostics. The hope is Eligard and Erleade will shrink the volume of tumor cells and in shrinking provide sufficient space between the edge(s) of the tumor(s) and the vital organs to permit Proton Therapy. Or perhaps some other form of External Beam Radiation. During the consultation with the MO I advocated to no avail for chemotherapy in addition to Eligard and Erleade. Brachytherapy, radioligand, and immunotherapy were not discussed.

To state what has been stated ad nauseum, a balance exists between maximizing the aggressiveness of the COT and the degradation of the QoL, Quality of Life. I am 83 but in good health so I advocated maximizing the aggressiveness of the COT. The MO pointed out that chemo at best degrades QoL and at worst is unbearable. Nothing is guaranteed, i.e. 18 weeks or more of chemo does not guarantee more than 18 weeks of good QoL as a reward. It was a risk I was willing to take since no one knows how they will respond to chemo without getting it.

The moral of the story is you have to consider what you think is the optimal COT with what your care team thinks is the optimal COT which may be the SOC, Standard of Care, COT. Not to be overly melodramatic, it is your longevity on the line versus their medical expertise if a divergence exists.

As an aside I have been on Eligard since 25 April and Eligard + Erleada since 4 June with absolutely no side effects. Eligard alone in 3 weeks decreased my PSA from 37ng/mL to 25ng/mL and my total testosterone from 517ng/dL to 57ng/dL.

Fortuna Erudites Favet