My Gleason score is 7 - 3+4. How long can I live without treatment?

Dave, Orgovyx isn’t bad at all. Exercise with weights a bit more to keep your tone and watch the carbs, but other than that it’s no biggie.
The hot flashes can be annoying and maybe in Florida a little more impactful if you are outside on a hot day, but even those are transient and not too much to handle.
Phil

I would like to know what kind of ADT your relatives had that caused their complications and ultimate deaths.
Many of the older types were really estrogen injections, which DO cause cardiovascular events (the older birth control pills were notorious for this). But newer drugs like Orgovyx simply block the production of testosterone - they don’t add estrogen - so whatever estrogen you were producing stays the same.
Of course, an extended stay (years) on any type of ADT can cause issues in some men with predisposing conditions or lead to castrate resistance, but a 6 month or one year course of Orgovyx is not going to kill you and may, in fact, save your life.

Two aspects I haven’t seen mentioned yet, one is velocity of your PSA, the other is PiRAD numbers from an MRI, further indication of aggressiveness.

First diagnosed as 3+3 in 2017 and did active surveillance until Stayed there until third biopsy in 2024 indicated gleason score of 3+4. Decipher score was slightly higher than intermediate risk. Urologist recommended treatment. Decided on SBRT (5 sessions) after talking with Radiology Oncologist, which was completed on October 30th of 2024. Had roughly 4 months of Orgovyx. Urologist wanted to do another 4 months but I said no. Radiologist said complete what you have which ended 12/4/24. Recommend talking with several doctors to determine what is best for you. Biggest issue with Orgovyx was being tired, a little moody and no libido.

Have you had an MRI or PSMA PET scan to evaluate any spread outside the prostate? Had second opinions on your biopsy slides? ArteraAI evaluation to determine the efficacy of ADT? Decipher to gauge risk? Read Patrick Walsh’s book. Unfortunately my experience so far has been less than inspiring with the various medical professionals I have consulted with. I’ve had to ask for all but the MRI and PET. My impression is that you’re going to get cookie cutter solutions unless you luck out and get a good doctor. Sadly this has been my experience with both my local and Rochester Mayo doctors to date. Unless you push them you will run the risk of getting over treated and all the lovely diminished quality of life side effects that treatment protocol entails. Ask lots of question and do lots of your own research. Don’t settle for just one consult. Every man’s prostate cancer is unique and cancer doctors are busy treating our 1 in 8 cases. Don’t be a just another passive number and advocate, advocate, advocate for yourself. Don’t settle for the possibly outdated NCCN standard guidelines they might still be using or the MSKCC nomograms that may marginally reflect current today’s outcomes. Research and new developments are moving at lightning speed like everything else today. ArteraAI testing was NEVER mentioned to me by 4 separate providers and it is now included in NCCN treatment guidelines. Prostectomy was pushed by surgeons and radiologists wanted to radiate. They both pushed ADT. I had radiologists run the spectrum from 40 to 20 to 5 fractions. By the way, 40 pays the centers better than 5. I was diagnosed with 4+4 prostate contained cancer on October 2, 2024 and have taken my time. I’m glad I did or I would likely be wearing a bag right now. Best of luck regardless of the path you chose for yourself. It is YOUR CHOICE.

Long term rather than short term ADT? It is my understanding that long term ADT can affect the heart, lipids and bring on diabetes. Short term doesn't have these affects from what my provider told me. Actually, told me to be as active as I can tolerate and officiate spring sports season. I will see about that after I finish 25 radiation sessions.

@heavyphil. Sorry I am not aware of which ADT they were on . Both passed 4 plus years ago .
One was two months shoort of his 90th birthday , Google : Dr. Hamish Small , a distinguished world renouned research scientist . His brothher passed at age 86 . Both were in excellent physical and mental health -- No pre existing issues , And both very active in : walking , golf , cross country sking , kayaking etc . Both surprisingly discontinued having a PSA . Hamish's cancer was diagnosed following a concerning " Alkaline Phosphatase number . Ian , from other indicators and finally a Biopsy . Both were Stage 4 when diagnosed . Both lived less than 2 years after diagnosis .

My Urologist' s , plural ,did not cover this risk . Both my brother-in-laws passed as a result of these side effects . Plus a current associate is having cardiac related issues . I am aware that the ADT medications have advanced in recent years which mitigates these side effects -- but NOT TOTALLY . It is a much higher risk if you have a pre existing condition .

Thanks Phil, I hope so. I already run 30 or so miles per week and lift 2-3 times so will continue and maybe even increase the lifting a bit. And it's only 6 months.

Wish I considered that being. 78 yrs young