PET Scan Results in

Your situation sounds almost identical to mine. The surgery can debulk the main tumor and reach local nymph lymph nodes that contain cancer. Let’s hope they get it all!

I’m speculating here, but I’m guessing that you’ll probably be prescribed both first generation and second generation ADT. My oncologist wanted to give me Lupron for first generation ADT but I opted for OGOVYX because the men that I had talked to that had taken ORGOVYX instead of Lupron had less fatigue, less hot flashes, and no depression. That has been my experience too for the last four months. It’s on the expensive side, but I applied for financial assistance and I have zero co-pay. Honestly, if I had to pay it out-of-pocket, I would. I think it’s that much better than Lupron shots. For second generation ADT I am on generic Zytiga also known as abiraterone. I purchase that through Mark Cuban cost plus pharmacy and my out-of-pocket is only $128 per month.

I’m guessing that you’re going to have to receive have to radiation to the prostate bed as well as the pelvic lymph node basin. My surgeon recommended that I make good progress towards continence before starting radiation therapy because at least temporarily it only makes incontinence and leakage worse. I started radiation two months after starting ADT which worked out to be four months after surgery. If you need information about how to cope with side effects from radiation when the time comes, please feel free to hit me up with a private message.

I’ve been told that only five years ago, they were unable to treat patients with similar conditions to you and me. Thank God times have changed. In the words of my wife, we’re in the same boat and it’s not the Love Boat because of ED from surgery and ADT, but it’s not the Titanic either because we both should have a chance for a cure.

Good luck on your journey.

Thank you. I will be hitting you up with tons of questions!!

I'll echo @robertmizek 's experience that combining ADT like Orgovyx with a second-generation ARSI like Erleada after radiation and/or surgery feels like a game changer. It might be the biggest advance in the treatment of advanced prostate cancer so far this millennium.

The results from studies like TITAN have been so encouraging that they had to unblind that study halfway through and let the placebo group switch to Erleada (Apalutamide), because it would have been unethical not to give them the same help.

Don't know what your pathology is but this seems like it would have to be managed and treated as locally advanced/regional. The scan showed one area with extraprostatic uptake. Since the imaging has finite resolution/sensitivity, you have to assume there is microscopic extraprostatic disease in the pelvis. I assume that will lead to radiotherapy of the pelvic region and a booster dose to the location that lit up, in addition to removing or radiating the prostate + a course of intensified hormone therapy. Long term disease control under those parameters is excellent -- better with intermediate risk, not quite as good with high/very high risk.

I am a T3a, Grade 5, Gleason on 2 out of the 5 were 9, the other three are 7's.

That’s virtually identical to what my results were. My oncologist and surgeon are hopeful that between the salvage prostatectomy, the salvage radiation, the ORGOVYX and abiraterone for two years I can illicit a cure or at least long-term remission.

Best wishes for success on your journey.

Let's keep each other posted! Nice to have someone who is "close" in diagnosis. Is there a difference between a salvage prostatectomy and an RP?

Prostatectomy becomes a salvage Prostatectomy when it is secondary treatment after a primary treatment fails.

In my case, the primary treatment was LDR brachytherapy which failed miserably. Normally, prostatectomy isn’t done after any form of radiation because the surgery is so challenging and risky, but my circumstances allowed it and it avoided the need for a urinary diversion, (ostomy bag) that I would’ve needed if I had had more radiation to the prostate.

Yes, let’s stay in touch. Don’t hesitate to send me a private message and I will do the same.