ADT for several months before Radical Prostatectomy

I had ADT and erleada before surgery to shrink the tumor and assist with the surgery It was a successful treatment

TM91,
ADT shrinks the tumor while preventing it from growing. In the case I'm most familiar with the one tumor shrank by half and the other tumor appeared only as a shadow on the PSMA. In an unusual circumstance PSMA/PET was administered the day before ADT and exactly two months after. Repeat PSMA was done in order to determine if a low SUV node was prostate cancer. The key was that if the node was NOT evident on the second PSMA then it WAS cancer. If the node were still evident on the PSMA then it was not cancer.
So I would agree that taking ADT could complicate the surgical margins. Even so all the surgeons consulted advised two months of ADT as the (ridiculously labeled) "sweet spot."
Margins are usually smaller with radiation than with surgery, But radiation is whole organ and there will be smaller amounts of radiation external to the radiation margins. A lower dosing isn't possible where you are removing the tissue.
All of the is just musing. Now for my opinion. Find a center that has either Linac or MRIridian Vewray with concurrent MRI guidance. See if the 5 fraction 40gy is appropriate with your tumor.
Bless your choice.

@hbp @gently thank you both.. I’m headed for surgery at 61yrs old. It’s just a question of ADT before for 2/3 months or not. It’s sounds like in @hbp case it was helpful.. thanks for the input

@gently btw both RO’s thought I should have surgery too which has made me confident in the decision to have surgery vs radiation

Just a layman’s opinion but G9 with EPE could be a more aggressive type of cancer. Only post-op pathology will tell the true tale.
Many doctors recommend ADT and/or radiation after surgery if even one node is positive in G9, so taking it before surgery is not a bad thing IMO. It’s not like 2 months of ADT is going to change your prostate/lymph anatomy SO MUCH that a good surgeon is going to be lost or confused.
Protocol dictates removal of gland, capsule, seminal vesicles and possibly Cowpers glands as well. Lymph node dissection usually includes 6 or more on each side. None of this should change with ADT before surgery and will help slow down the growth of any cells which may have gotten out thru the EPE. Just my thoughts. Best,
Phil

@heavyphil that’s exactly what I was looking for advice wise. Thank you

@heavyphil @hbp @gently I had a virtual meeting with Dr Byron May of Mayo Jax he is a R/O. He was fantastic and promised to arrange for a consultation with the surgical team. Apparently there is a Tuesday morning meeting where they present cases and he offered to bring my case in and hopefully expedite my next step. I’m hoping to get an answer quickly. I’ve also been to Cleveland Clinic in Weston FL. They suggested the ADT regimen before a radical. I’m waiting to see what Mayo says. I feel my case is straightforward but challenging given G9. I’m 61 and in excellent shape. I know I may need other treatments after surgery but I feel giving surgery a shot with ADT before could be a chance to get ahead of it. My family history is strong. Both parents had different cancers and lived into their 90’s. 🤞

@jeffmarc @kujhawk1978 if you have an opinion on above I would really appreciate your opinions. You both seem to be very knowledgeable. I understand if you don’t feel comfortable opining. Thank you. @tmestanas91

I think the advice you got from other people is quite appropriate.

I’m a little surprised that the surgeon doesn’t want you to take ADT. Is it possible your prostate is smaller than usual, and it would get even smaller with ADT? On average ADT shrinks the prostate by almost 47%.

If you were to do the surgery soon, then ADT would not be necessary, If you wait, many months, ADT is really important to stop your cancer from growing.

With the Gleason nine, there is a likelihood that the cancer will reoccur. If you get surgery then you can follow with salvage radiation. If you get radiation, surgery is difficult and usually not done. You could get a decipher score to see if it’s high, though Gleason 9 is also shown to cause high reoccurrence, Your doctor may say that’s an assumption you can already make, but it can’t hurt to ask.

Well, wish there was a definitive answer, there is not.

Surgery is an option, we generally understand the risks and side effects.

MSKCC has a nomogram that can provide statistical information about the success or not of your surgery, both pre and post https://www.mskcc.org/nomograms/prostate

With that clinical data, in the past, doctors may not have chosen surgery since it carries a higher risk of De Novo Metastatic ve De Novo Local. More and more I have seen the thinking gravitate towards surgery in your case, akin to taking out the mother ship. Then, adjuvant therapy with ADT, ADT+ARI

If the decision is surgery with adjuvant therapy, then may not need imaging with PSMA since it doesn't necessarily change the treatment decision.

Same for doublet or triplet therapy. PSMA imaging may not change the treatment decision.

Generally what I have seen in high risk De Nov PCa is to image with PSMA, then decide on treatment.

So, to sum it up.

Surgery is an option likely followed up with subsequent treatment though.

Doublet or triplet therapy definitely options https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc

Kevin