SBRT Monotherapy (No ADT)

The thing is, The decision to drop ADT is based on many issues, including Gleason score, which you don’t tell, and other things found in the biopsy. Any of those things can make your case different from somebody else.

If you’ve gone six months undetectable, some doctors would say you can stop ADT. If you have a Gleason nine or 10 it could backfire on you, But you can try it and see if your PSA rises. If so, you get back on ADT.

I was Gleason (3+4) on 3 cores,
Negative for malignancy (0 / 2) on 3 cores. PSA t.9 in Nov 2024. 10.5 on Jan 24, 2025 by a different lab.
My next PSA test is due on July 8, to be discussed with my oncologist on July 15.

PSA 7.9 in Nov 2024.

@virvircet
I finished my 5 treatments with the mridian machine in February of 2023. My PSA started at 11.2 and I had no ADT. My doctor was fully aware of ADT being recommended if one's PSA was 11 or over but she felt that it would not be necessary. My last PSA a couple of weeks ago was .71 and I had reached my nadir of .66 a few months ago. She said that if my PSA rose a total of 2 points, she would be concerned about a re-occurrence. If it rose 1 point, she would go in and do a PSMA pet scan. She said that my PSA will float a bit and, based on my blood tests, she stated that roughly, a figure of .66 to .8 might be the range. Based on that, I would take the PSE test again if my PSA went to .8 as it does work for biological re-occurrence.

Thanks very much.
Now I realize that feedbacks from SBRT Monotherapy patients from 2018 up willl help. (Previously, I asked for replies from those who had SBRT before 2018 and took no ADT for years thereafter.)

Your Gleason score and volume do not appear to indicate aggressive tendencies…was your Decipher score high?
I’m just a layman but the ‘guidelines’ -which are not etched in stone - don’t really call for ADT for G3+4 unless you have genetic markers for metastasis.
My best friend had SBRT last year at Sloan and had a G4+3 in one of his cores, but a Low Decipher so he took No ADT. He was 73 yrs old at the time.
Phil
Phil

Thanks, Phil. At the cancer center where I got treated, they don't offer Decipher tests, and rarely the spacer. (Maybe due to budget constraints in a universal, tax-funded health care?) The urologist who did my biopsy was in another (regional) hospital; he said I was "unfavorable intermediate." He does open surgery only, so he referred me to the cancer center (among the best in Canada) for SBRT. Here, the oncologist indicated I was "intermediate." Nevertheless, I was prescribed Orgovyx.
Had the urologist nót said "unfavorable," I might not have started Orgovyx at all. This was a compromise with my oncologist (who initially would have given me the once every three months ADT injection), so that I can stop ADT if I experienced the side effects I was very worried about.
I have experienced little or no side effects in two months, so I will discuss with my oncologist when we meet in July. Maybe I can stop after 6 months max, instead of 8 months to a year initially mentioned to me.

Is it possible there is something in your biopsy besides the 3+4? Guidelines call for six months of ADT if you have 3+4. Any reason the doctor wants to keep you on it longer? Is it because you had it before you had radiation So they are extending it to six months past treatment?

I was G3+4, at first favorable intermediate but changed to unfavorable intermediate due to a small extracapsular extension, which had not spread any further. The Artera test indicated a significant reduction in distant metastasis with 6 months of ADT. So I have about 6 weeks to go on that.