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ADT for several months before Radical Prostatectomy

Posted by TM91 @tmestanas91, 2 days ago

I’m working with two COE’s. 61yrs , excellent shape. One has suggested shrinking the prostate with ADT to gain better margins with surgery ( G9, EPE, no spread to lymph nodes or elsewhere). The other is also recommending radical surgery but they are saying doing ADT prior will complicate the surgery. Studies I have read suggest it helps the surgeon get negative margins but other aspects of long term benefits are undecided. Does anyone have a view? I’m fine doing the ADT since I feel I have one shot at getting this ( hopefully) the first time. Please share your view.

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heavyphil | @heavyphil | 17 hours ago
In reply to @tmestanas91 "@heavyphil So I haven’t started any treatments yet. Yes, I understand that ADT slows and shrinks..." + (show)
@tmestanas91

@heavyphil So I haven’t started any treatments yet. Yes, I understand that ADT slows and shrinks but doesn’t kill Pca. Current plan from CC is to do several months of ADT and then surgery. I’m waiting to hear recommendation from Mayo Jax . The RO I met with at Mayo thinks surgery best option. I’m hoping to hear from the surgeon there this week. Thanks for clarifying. 🙏

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Yes….my reply was to @krs03 but these mix ups happen a lot on the forum….comment and reply are often used interchangeably.

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krs03 | @krs03 | 12 hours ago
In reply to @heavyphil "Are you having radiation in addition ADT? Even with undetectable PSA you still need radiation to..." + (show)
@heavyphil

Are you having radiation in addition ADT? Even with undetectable PSA you still need radiation to scramble the DNA of the remaining cancer cells and hopefully destroy them.
The nodal dissection indicates escape of cells and they are not always captured by the lymphatic system.
I’m sure you know this already - just saying it for the benefit of those uninitiated observers on the forum who may conclude that ADT alone “kills” PCa.
Best of luck,
Phil

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Yes, understood. My surgeons don't suggest radiation for some time, I'm 14 weeks post RP. There is also the 'salvage' philosophy saying that no intervention is needed until there is a significant rise in PSA (0.5 or even >0.2). My counter argument is: I've never had a PSA above 10 and have had significant PC. So should I trust just this measure?
The adjuvant path is more aggressive in my view and has ADT along with SBRT for instance. When I have the oncologist on-board I'll express my concerns. Still there is a suggested healing time after surgery prior to any radiation.
Thanks Phil

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1 reply
heavyphil | @heavyphil | 10 hours ago
In reply to @krs03 "Yes, understood. My surgeons don't suggest radiation for some time, I'm 14 weeks post RP. There..." + (show)
@krs03

Yes, understood. My surgeons don't suggest radiation for some time, I'm 14 weeks post RP. There is also the 'salvage' philosophy saying that no intervention is needed until there is a significant rise in PSA (0.5 or even >0.2). My counter argument is: I've never had a PSA above 10 and have had significant PC. So should I trust just this measure?
The adjuvant path is more aggressive in my view and has ADT along with SBRT for instance. When I have the oncologist on-board I'll express my concerns. Still there is a suggested healing time after surgery prior to any radiation.
Thanks Phil

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I am a bit confused. You had a Lupron shot, but then say if your T rises you’ll want to go on Orgovyx. Don’t think you can do that - how will you ever measure your 3 month PSA’s accurately if you are on ADT?
So if you are anxious about a rise in T/PSA and you desire ADT, you almost have to have radiation sooner, way before the .2 level. If you don’t you “could” become castrate resistant (emphasis on could) the longer you stay on ADT without doing something definitive about the cancer. Radiation will damage cancer DNA and hopefully the cells will die. That’s the one-two punch you need.
It’s good that you are consulting with someone other than your surgeon. Surgeons will always tell you to wait as long as you can in the hope that their surgery will be successful. They never want to share the glory with a radiation oncologist who steps in and mops up what they missed. No judgment just the facts.

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1 reply
krs03 | @krs03 | 8 hours ago
In reply to @heavyphil "I am a bit confused. You had a Lupron shot, but then say if your T..." + (show)
@heavyphil

I am a bit confused. You had a Lupron shot, but then say if your T rises you’ll want to go on Orgovyx. Don’t think you can do that - how will you ever measure your 3 month PSA’s accurately if you are on ADT?
So if you are anxious about a rise in T/PSA and you desire ADT, you almost have to have radiation sooner, way before the .2 level. If you don’t you “could” become castrate resistant (emphasis on could) the longer you stay on ADT without doing something definitive about the cancer. Radiation will damage cancer DNA and hopefully the cells will die. That’s the one-two punch you need.
It’s good that you are consulting with someone other than your surgeon. Surgeons will always tell you to wait as long as you can in the hope that their surgery will be successful. They never want to share the glory with a radiation oncologist who steps in and mops up what they missed. No judgment just the facts.

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You are making the point the Surgeon (Fellow, 2nd dude in the surgery) said about CR, castration resistant PCa. It's still unclear to me how that takes place and what to do in order to prevent that.
I hear that there are men years and years on ADT, and not resistant. I really don't want to see my PSA rise and would want to squelch that with whatever means possible. My ignorance is showing, and without the advice of an oncologist I'm partially blind.
I'm getting a referral for a GU oncologist (GenitoUrinary) which should be a good 1st stop. Next is a Radiation Oncologist at a closer medical facility.

My next searches will be PBT vs. IMRT vs. SBRT. Sounds like the PBT causes the least side effects, but may not be covered or even available to me.
Thanks once again, HP

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1 reply
heavyphil | @heavyphil | 4 hours ago
In reply to @krs03 "You are making the point the Surgeon (Fellow, 2nd dude in the surgery) said about CR,..." + (show)
@krs03

You are making the point the Surgeon (Fellow, 2nd dude in the surgery) said about CR, castration resistant PCa. It's still unclear to me how that takes place and what to do in order to prevent that.
I hear that there are men years and years on ADT, and not resistant. I really don't want to see my PSA rise and would want to squelch that with whatever means possible. My ignorance is showing, and without the advice of an oncologist I'm partially blind.
I'm getting a referral for a GU oncologist (GenitoUrinary) which should be a good 1st stop. Next is a Radiation Oncologist at a closer medical facility.

My next searches will be PBT vs. IMRT vs. SBRT. Sounds like the PBT causes the least side effects, but may not be covered or even available to me.
Thanks once again, HP

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No apologies about ignorance allowed - we are ALL struggling to understand the many contradictions- and exceptions to the norm - this disease presents. Your consults will be another step in getting a grip on a treatment plan.
Castrate resistance is another enigma which happens to some men and not to others on ADT for many years - who knows why?? But the chances for it happening seem to increase the longer you are on it. Many docs even believe in “holidays” where ADT is discontinued for months at a time.
If you want to squelch a rise in PSA, ADT is the answer - but only as an adjunct to radiation following RP. It is NOT definitive treatment in your case.
The RO consult should be especially informative since it will go over the what, how and why so write all your questions down - and the responses as well so you can refer back later; your brain will ache from all the info thrown your way. A spouse, partner, friend or relative being there is also helpful…Best,
Phil

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