Has anyone been prescribed hormone therapy prior to surgery?

Posted by riverdancer @riverdancer, Jan 5 12:29pm

My husband is at the decision stage between hormone therapy and radiation or surgery. Localized tumor based on PSMA PET, Gleason score 9(4+5) PSA 9.2, clinical stage T1c, considered high risk/very high risk, Decipher Genomic risk group was determined to be low 0.38 which apparently indicates lower risk of spreading. We are acting on the high risk end of things and need to make a decision soon. If he decides to do robotic surgery, it may be a month before he is able to meet with a highly recommended high volume robotic surgeon, and then we don’t even know if he decides to do the surgery, when that would happen. Meanwhile, the cancer grows. We asked the staff at his urologists office about taking hormones while waiting to meet the surgeon (who is outside of their practice) and were told that is not typical practice. Has anyone been prescribed hormone therapy prior to surgery? The prostate is going to be removed anyway so I wouldn’t think it would matter. Thank you for any input.

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riverdance, a surgeon at USC and another at UCLA recommended two months of lupron or orgovyx before surgery. It is more valuable where the cancer is near a nerve bundle or close to seminal vesicles. You might call the surgical office of the recommended robotic surgeon, talk to his nurse or get the question messaged to him.

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Hormone therapy is very common for two or three months before surgery. Many radiation oncologist want you to do that?

He has an aggressive cancer so you want to get on ADT If you can’t get something done in a very short time. He can ask for Orgovyx which is a daily pill. It’s better than Lupron, eligard or Fermagon in a few ways Ask the urologist.

You should try and get a 2nd opinion from a center of excellence. If you do that multiple doctors will work with you to come up with the optimal treatment

When it comes to radiation, you can have SBRT which only takes around five sessions but there are multiple types of radiation. There is cyberknife SBRT and MRIdian SBRT then there are at least two types of brachytherapy. You also have many other non-radiation treatments are HIFU, cryotherapy, TULSA-PRO or more (others here may recommend).

You may want to consult an oncologist, preferably a Genito urinary oncologist who specializes in prostate cancer. They will set you up with a radiation Oncologist to discuss radiation, and other doctors to recommend other techniques.

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@gently

riverdance, a surgeon at USC and another at UCLA recommended two months of lupron or orgovyx before surgery. It is more valuable where the cancer is near a nerve bundle or close to seminal vesicles. You might call the surgical office of the recommended robotic surgeon, talk to his nurse or get the question messaged to him.

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Thank you, we do have a call in to them. Also considering doing telehealth call with Mayo Clinic if possible.

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Hormone therapy will slow down or stop the spread of any cancer that might have escaped the prostate but not grown enough to be detectable yet. With a Gleason score of 9+, I would take every opportunity they offer your husband to put on the brakes between now and surgery or radiation.

If he opts for surgery, they might also suggest salvage radiation afterwards to catch any cancer that might already have moved into the area just outside the prostate.

Testing concluded that I don't have a genetic predisposition to prostate cancer, and yet mine had already spread to my spine by the time it was detected. In my non-professional opinion, Gleason 9 *always* needs to be taken seriously and treated quickly.

We have good treatments now to manage metastatic prostate cancer like mine, but it's so much better to avoid it in the first place if you're blessed with an early warning, as your husband has been.

Best of luck!

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I also was a Gleason 9 and I was on Orgovyx for 2 months before surgery. I dropped my PSA quickly.

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@northoftheborder

Hormone therapy will slow down or stop the spread of any cancer that might have escaped the prostate but not grown enough to be detectable yet. With a Gleason score of 9+, I would take every opportunity they offer your husband to put on the brakes between now and surgery or radiation.

If he opts for surgery, they might also suggest salvage radiation afterwards to catch any cancer that might already have moved into the area just outside the prostate.

Testing concluded that I don't have a genetic predisposition to prostate cancer, and yet mine had already spread to my spine by the time it was detected. In my non-professional opinion, Gleason 9 *always* needs to be taken seriously and treated quickly.

We have good treatments now to manage metastatic prostate cancer like mine, but it's so much better to avoid it in the first place if you're blessed with an early warning, as your husband has been.

Best of luck!

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I cannot agree more with your response. These tests and scans guarantee nothing. You gotta blast this thing - especially with higher Gleason scores.

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18 years ago my husband's psa was 70 with a Gleason of 9/10. He was 48. Sloane Kettering toldHim to go home as he was too young and his numbers too high. Translation: he wouldnt survive and he would mess up their stats if he died. Instead, he went to Columbia and NYU. He decided on NYU. He did Lupron prior to surgery. I don't remember how long he was on before surgery. 6 months later psa started to rise. His dr did salvage radiation. He went on off various treatments. He survived for 17 years. Please talk to the best drs you can find. Don't settle for one drs opinion. Talk to 2 or 3 different oncs that specialize in prostate cancer.

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@cob13

18 years ago my husband's psa was 70 with a Gleason of 9/10. He was 48. Sloane Kettering toldHim to go home as he was too young and his numbers too high. Translation: he wouldnt survive and he would mess up their stats if he died. Instead, he went to Columbia and NYU. He decided on NYU. He did Lupron prior to surgery. I don't remember how long he was on before surgery. 6 months later psa started to rise. His dr did salvage radiation. He went on off various treatments. He survived for 17 years. Please talk to the best drs you can find. Don't settle for one drs opinion. Talk to 2 or 3 different oncs that specialize in prostate cancer.

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What a terrible experience you both had! So much for the Hippocratic oath. Every doctor involved should have lost their license to practice medicine.

My PSA at age 56 was almost identical to your husband's when I was first diagnosed in 2021 (and the cancer had already metastasised to my spine). I'm grateful that the healthcare system here opened its arms to me and pulled out all the stops to help me, even before I fully understood what was happening.

Any time is too soon to go, and of course you're still grieving (and always will be), but it means a lot to me that you shared your story: if I get 17 years from when I was diagnosed, it will be a huge victory.

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@riverdancer

Thank you, we do have a call in to them. Also considering doing telehealth call with Mayo Clinic if possible.

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@riverdancer, if you would like to request a second opinion from Mayo Clinic experts, you can start here: http://mayocl.in/1mtmR63

How are you and your husband doing with the treatment decisions?

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