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Gleason 7 (4+3) radiation, but ADT also? Over treatment?
Hello,
I will be 80 next August and apart from newly diagnosed PC am in good overall health. I have a diagnosis of Gleason 7 (4+3) Grade 3, T2a with a five year PSA of 0.6. Six cores positive in the recent biopsy. No spread to the bones or organs as indicated by CT scans etc. I see my urologist on 7th January and am concerned that he will propose ADT in addition to the inevitable RT ( I suspect IRMT ).
The side effects concern me ( although I already have erectile dysfunction ) mostly those concern possible memory loss, bone and muscle loss and cardiovascular risk ( I have controlled high blood pressure ).
I have read several recent reports that indicate that ADT may represent overtreatment in older patients and the more so where the cancer grows more slowly. Quality of life is key for me and my wife.
Can anyone please give a measured/qualified overview please. Thank you.
David
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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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I feel sure that most forum members will be aware of the PCRI in Los Angeles. Run by Dr Mark Scholz and team it is a mine of information. Their You Tube page 'Alex Scholz' has masses of highly relevant videos and this one is no exception and seems to relate well to this discussion............
'Intermediate-Risk: Do You Need Hormone Therapy With Radiation?"
David
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1 ReactionJeffmac,
I started computer programming as a student at University of Michigan in 1961. Later, I wrote operating systems software and compilers for Burrows machines. Finally retired as a Data center manager at County of Los Angeles in 2005.
Dr. Schulz suggested that I should take a holiday now from Orgovyx. But, my computer mind tells me that I should continue until my PSA reaches a plateau or at least 12 months whichever comes first. just finished 9 months.
My reasoning is if PSA dropping means treatment is working, so why stop the medicine. My quality of life with hormone therapy is not great but certainly acceptable that I can live with it rest of my life if I have to!
My PSA on October 7th was 0.05. I am hoping it will keep dropping some more in the next 3 months.
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2 ReactionsI understand your desire to continue taking the drug because your PSA continues to drop. Your PSA however, is very low, And that is why Doctor Scholz Said you could stop Orgovyx. Taking the drug for another three months is no big deal, your testosterone will probably come back just as quickly with that small addition of time.
A lot of people don’t get the ultra sensitive PSA test so for them being < .1 For nine months would be enough for some people to say drop the drug And see what happens.
I’m sure you’ve Read other comments about this, discussing the fact that you should get PSA tests no less than every three months when you do drop ADT. Wish you the best with your treatment decision, Hopefully it will give you years without recurrence.
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1 ReactionThank you Jeffmarc for your comments. Dr Amar Kishan when he treated me with SBRT in April, he suggested ADT for 1 year. I asked him what if I don't take ADT. He said my cancer coming back is 50%. ADT cuts it down by 50%. That means there is 25% chance that cancer coming back!
When I told him that Dr Schulz said that I can stop ADT now, he said it is ok!
It is all probabilistic, nothing definitive for sure!
Might be an idea to get your guy to read the two recent reports I cited earlier in this thread clearly questioning the marginal difference made by ADT over modern radiation. Maybe he already knows them. My guy did not.
As you suggest, its something of a lottery.
David
I just turned 77, Gleason 4+3, always PSA < 1, Grade 3, T2a; However I have a mixed morphology of acinar and the more aggressive ductal. No spread to the bones or organs as indicated by CT scans. bone scan and PSMA pending. I also have read that ADT may represent overtreatment in older patients.
I am otherwise in near excellent health. Wondering what to do about ADT?
Wait and see what the PSMA PET scan finds.
Six months of ADT for a 4+3 is no big deal. I was on it for eight years and over time. It really hasn’t been that much of a problem. I do walk on a track twice a day for about a mile each time. I never did feel much fatigue from ADT, not everybody does. Yes, I got a lot of hot flashes at the beginning, but there are solutions to hot flashes. You do need to take something for a bone health if you are on it for more than six months.
After prostatectomy, my PSA was 4+3. I didn’t have ADT and it reoccurred 3 1/2 years later. I had salvage radiation and it lasted 2 1/2 years before I had a reoccurrence. If I had been on ADT, maybe I would not have had the reoccurrences.
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2 ReactionsDuctal IS considered more aggressive, as you point out, so IMO it needs a bit more in terms of treatment.
After your PSMA, options are surgery or radiation; and ADT would be recommended with RT because of those more aggressive cells. Also, a ‘brachy boost’ of high intensity seeds could be placed in the more serious glandular areas to hit those cells the hardest.
If you opt for surgery it’s a more ‘one shot’ type of thing but there are MANY dide effects
Sorry!! Morning Thumb Syndrome😩…I meant to say many SIDE effects from surgery which you may not want to go through at this point in your life. But ADT probably would not be used if you had surgery.
But ADT is not all that bad (ask for Orgovyx) and if you are in good shape the SE’s are more of a nuisance than anything else.
Phil