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Treatment options: radiation without ADT?
Prostate Cancer | Last Active: Jul 28 9:17am | Replies (39)Comment receiving replies
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!
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Hi Phil: The PSMA Pet Scan should be highly accurate (90% accurate) in pinpointing where the culprit might be - in the original prostate bed or elsewhere. My guess is that in a salvage radiation (post-surgery) situation, they will be pretty adamant about administering 6-months of ADT. That said, there are multiple new hormone therapies that have evolved that have less metabolic impacts than the traditional ADT (Eligard) that I had in conjunction with my proton radiation. You may have to pay out-of-pocket for it and be assertive with them to go in that direction but for sure let them know you want to know all the alternatives. On a positive note, a friend of mine had recurrence 5 years following proton radiation - had 6-months of traditional ADT with some targeted radiation and so far so good. The advent of the PSMA scan prior to surgery or radiation has been a game changer. And it will be your friend as well, because they will know exactly where to go with any salvage radiation. Stay positive! This is a lifelong affliction and journey for all of us but the advancements in the past few years are on our side Phil. Wait for your scan and go from there. It's easy. They give you a shot - you wait for half an hour for it to permeate your system - the scan itself takes a few minutes. All the best tomorrow. I just tripped off my dock today and broke my ankle so one more hill to climb! Just have to stay positive.