The treatment begins. I hope it makes sense.

I have similar set up. G9, PNI, no spread. Working with center of excellence in S Florida. I’m 61 in excellent shape. I’m leaning towards starting ADT( Orgovyx and apalutamude) for several months and then having RP. Surgeon thinks he can get good margins. This is not a typical protocol but I’m going to try it. It’s aggressive cancer.. I want to be aggressive. I’m also getting 2nd opinion from Mayo Jax. Good luck.

This sounds like a good treatment plan. You might prefer taking Orgovyx. It’s a pill you take once a day. It replaces the Casodex and the Elgard injection. When you stop taking Orgovyx Your testosterone comes back much quicker than with Eligard. You will probably be on these drugs for 24 months.

Almost all insurance plans cover it now. It works just as well as the Eligard shot. Ask your doctor for it.

Cribriform is very aggressive, Another reason this treatment plan makes sense.

With the Gleeson nine, the ADT treatment will Usually stop your cancer from Growing and can shrink it for radiation.

TM I am G9 CR advanced incurable etc.with a poor prognosis I had lupron and erleada 6 months then RP then these same drugs for another 6 months. That started 40 months ago and I have remained undetectable. Now 78 and I am exceeding my doctors and my expectations Your doctors recommendations sound similar to my doctor Good luck to you and all

@hbp Remain undetectable!!!

Stew, it sounds very proactive, which is good…Orgovyx might be a better choice for ADT.
And most importantly, I think you mentioned you are 83. I firmly believe that surgery is NOT an option for an 83 yr old man. I may risk the wrath of Colleen for saying that but you are too freakin old to go thru that and then STILL need radiation in a few months or a year.
There are plenty of radiation based options which have varying side effects, but nothing as bad as surgery at your age.
There’s HDR brachytherapy with SBRT….SBRT alone….IMRT, etc.
If you were anywhere up to maybe 70 yrs of age, surgery would be an option due to the fact that a longer anticipated lifespan might allow for recurrence; at 83, not so much….Best
Phil

Thanks Phil. I agree with you regarding surgery. Radiation and ADT seems like the way to go. They hinted about brachytherapy (I'll know more in June) but I heard the doesn't work well if a previous Turp has been done. I had a Turp several years ago.
I'll ask about Orgovyx (Relugolix). I don't hear much about it here for some reason although I know it was approved for use several years ago in Canada.

You have received some good input! I was Gleason 9 with extra prostetic extension and cribform. I had the option of surgery first, but opted to go with just radiation (Proton Therapy) following the first three months of a 2 year stretch of ADT (lupron + abraterone) to avoid the surgical side effects with a comparable statistical outcome. My last 3 month injection was 15 months ago and PSA has been undetectable ever since my third month on ADT. As others have said, the time on ADT isn't easy, but it can enhance the impact of the radiation if you can deal with the side effects. Best wishes to you on a tolerable treatment and positive outcome!

Thank you. Great to read undetectable.

Stew, yes the TURP is problematic; I had Green Light laser a few years before and one RO said that the middle of my prostate was hollow so where was he gonna put the seeds??
But the other radiation alternatives are also excellent. Orgovyx in Canada might be expensive (relative to Lupron) but please do look into it. If you can afford it I think it is well worth it because of its efficacy and reduced impact on your quality of life.

Funny how drug pricing is so different. In 2024 Kaiser decided to start charging for infusions. As a result, my six month Lupron shot now cost $400 every six months, Instead of $0.

On the other hand, Orgovyx Cost me nothing for the year. The first time I order a refill for Darolutamide I hit the Medicare maximum,

A little info on how Medicare paid/pays for prescription drugs
Last year I paid $3,237 refilling Darolutamide, once I spent another $100 on drugs the Medicare $8000 maximum for drugs was hit (Costs include what provider pays). everything that requires a prescription was free from the pharmacy for the rest of 2024. This year I paid $2000 for my first refill of Darolutamide, everything that requires a prescription is free from the pharmacy for the rest of 2025. Nice change to Medicare regulations, hopefully this doesn’t get changed again and changed back to 2024 regulations