ADT before surgery: Good idea?

I’ve seen the ADT requirement for radiation more often than I’ve seen it for surgery.

There are standards of care set up for prostate cancer treatment and the standard of care for surgery does not call for ADT ahead of time.

From a search
While neoadjuvant androgen deprivation therapy (ADT) before prostatectomy can reduce positive surgical margins and improve local pathologic variables, it's not yet considered standard care and its long-term benefits are still under investigation.

@jeffmarc Thank you. I had PSMA test 2/10.. surgery 3/26th should be good to go ! 🤞💪

Hey @tmestanas91 How did the surgery go? Mine is coming up Thursday (4/3) at Mayo (JAX).

I wanted to reply to your original question because I Googled the hell out of it before and never got a clear answer. Now I have my own results, so I am sharing that. For background, I am 60 yo with Gleason 8 and aggressive cells (cribiform). Seminal vesicle invasion and EPE.

Orgovyx for 3 months before surgery shrunk my overall prostate nearly 6% - 51 cc to 48 cc.

2 tumors: one shrank 44%, the other 19%.

The trade-off is you are waiting an extra 3 months and that could mean mets. I did not have lymph node or bone involvement, either before or now.

I half expect my surgeon to say he wants to continue the ADT. Not sure tbh. I'm ready to get this thing out.

All just FYI.

Steve

@smoore4 I’m a few days out of surgery.. first day was in the hospital.. I’m up and walking around now. Not a lot of pain. Just taking Tylenol. Went to brunch with my wife today. Catheter is uncomfortable and makes bathroom trips more difficult.. take stool softener and get a riser for the toilet.
I think with ADT you made Mets unlikely. That’s what Cleveland clinic recommended to me also. NYU said just do the surgery. You know the data is all over the place. Who is doing your surgery? I never got a firm answer from Mayo Jax on my treatment plan. It’s all about the pathology which you will get a week or so after. That along with following psa tests will determine further treatment.. we are in very similar boats. Let’s stay in touch.smoore4 I’m a few days out of surgery.. first day was in the hospital.. I’m up and walking around now. Not a lot of pain. Just taking Tylenol. Went to brunch with my wife today. Catheter is uncomfortable and makes bathroom trips more difficult.. take stool softener and get a riser for the toilet.
I think with ADT you made Mets unlikely. That’s what Cleveland clinic recommended to me also. NYU said just do the surgery. You know the data is all over the place. Who is doing your surgery? I never got a firm answer from Mayo Jax on my treatment plan. It’s all about the pathology which you will get a week or so after. That along with following psa tests will determine further treatment.. we are in very similar boats. Let’s stay in touch.

My surgery is tentatively scheduled for mid-June at Advent Orlando. I have been put on 50mg/day Bicalutamide in the meantime. So, not ADT but AR inhibitor. Almost no side effects.

FWIW: I just got my pathology review from Surgeon. I was downgraded from G9 to 4+3. Lymph nodes clear, negative margins. He was very happy with results as am I. I had deliberated on ADT before surgery but he suggested against it. He said now we know exactly what we are dealing with. Long road ahead but I’m thrilled first step was successful. Staying positive!