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Treatment options: radiation without ADT?

Prostate Cancer | Last Active: Jul 28 9:17am | Replies (39)

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@clyman

Hi Phil! Sounds like you had surgical removal of your prostate and the pathology confirmed Gleason 7 (4+3). I also assume that you have had a PSMA Pet Scan confirming the disease is confined to the prostate. Not sure the accepted Standard of Care protocol is exactly the same with respect to ADT administration for prostate removal vs SBRT Proton Radiation (which I had). But either way, I encourage you to watch the recent PCRI video narrated by Dr. Mark Scholz (medical oncologist) which addresses the newly published findings from a legitimate trial study regarding new thinking on the net benefits of ADT supplementation in the context of patients receiving radiation of the prostate. Dr. Scholz feels that the findings will ultimately lead to the standard of care for localized Gleason 4+3 prostate cancer to not recommend ADT as a part of treatment due to potential metabolic health risks of ADT not justifying fractional improvements in cancer recurrence or survival statistics. Because standards of care are slow to change and doctors rely on these to avoid future liability, I do not anticipate the new findings are going to be universally endorsed by individual urologists or radiologists. But the findings certainly do arm you with another legitimate discussion point relative to the ADT - No ADT decision. It will still be your decision but it might at least open up some true grit discussion that your doctors otherwise would be more casual or non-communicative about. If I had had the benefit of this new research in 2022, I am confident I would have foregone the 6 months of ADT. Just be assertive and don't rush a decision on ADT. It's nasty stuff on metabolic health no matter how good of shape you are in. I hope this helps.

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Replies to "Hi Phil! Sounds like you had surgical removal of your prostate and the pathology confirmed Gleason..."

Yes, had prostate removed 2019. Having PSMA PET this Tuesday actually. Even though I prefer not to have hormones I have to be realistic about the situation: Clean margins, nodes negative, vesicles negative….yet, it’s back…..or most probably it never left, right? So the bugger is persistent and could have evolved in time into something more aggressive. It scares me to think that if they don’t get it this time, my future will be totally hormone and chemo dependent with all the side effects you’ve all mentioned. And as was also mentioned, doctors are slow to embrace new thinking and tend to rely on tried and true (or not) methods to cover their asses.
Sloan is very much in this camp and follow their own time tested protocols to the letter.
I feel that if your initial treatment is radiation hormones may or may not be advised based on your Decipher score. My best friend ( Gleason 3+4) just had Cyberknife at Sloan and received NO hormones since his Decipher score indicated low chance for metastasis. I did mot have this test in 2019 so the docs probably have to err on the side of caution and overtreat. Just hope it’s 6 months and not longer….will keep you posted!