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Monitoring PSA post surgery with Gleason 9
Prostate Cancer | Last Active: Apr 12 1:10pm | Replies (18)Comment receiving replies
I am a little puzzled. You are a Gleason 9 and a decipher .99, Yet you only took ADT for six months.
The NCCN, Which sets the standard of care for prostate cancer patients recommends that Gleason 9 patients stay on ADT for a 18 to 24 months. Do you know why you only had to do it for six months? That can leave you with a risk of early reoccurrence. It is good to hear you are getting undetectable results.
Did you run that 6 months limit past your other doctors?
Did the somatic test show you had BRCA1 or BRCA2? The PARP inhibitor is most effective with those genetic problems but also works with PALB2, ATM, RAD51C and RAD51D
I know ADT can be a real pain, I was on it for eight years. I stayed on because it allows me to live longer.
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My healthcare provider said 18 months of ADT. Second opinion by Fred Hutch said 6 months. I asked Fred Hutch why such a divergence and confirmed their opinion that I was high risk. They said that the benefits of longterm ADT was a grey area but the systemic damage due to longterm testosterone deprivation was not a grey area. I researched the subject and found the research showed at best 8% benefit of 18 months ADT over 6 months of ADT . In addition the research says that intermittent ADT is “non inferior” to continuous ADT. Another issue, albeit also a grey area, is the high selection pressure of longterm ADT which may force castrate resistance mutation, especially with unstable cancer gene genetics like mine.
I opted to go ahead with the advice of Fred Hutch , a center of excellence and do 6 months ADT with monthly monitoring and the intention to back on ADT if my PSA started moving up.
As far as mutations and repair issues I had none in my germline genetic tests but serious ones in my somatic cancer cell testing hence the PARP Inhibitor comment from Fred Hutch.
I am not suggesting that the intermittent ADT approach is the best way forward but at 63, and a very active long distance athlete, if it’s easier on my body systemically due the “holidays” that’s my way forward. Fingers firmly crossed!