Gleason 7 (4+3) radiation, but ADT also? Over treatment?

Thank you for the advice. I am leaning towards radiation, something like 30-40 treatments seems to be what is recommended over SBRT. I am wondering if I need to have the treatment in a private clinic.

Why a private clinic? Are you in the USA?

My journey with prostate cancer began in late 2022, early 2023. I was 67 when diagnosed. I was a widower by this time and not in a romantic relationship. My Gleason score was 8, and after talking with my urologist, I chose radiation and hormone therapy. The reason, even with surgery, there is a good chance you will need hormone therapy because it is very difficult to remove all of the prostate while trying to minimize damage to other areas.
The good news is they have come along way with radiation treatments. I had 45 treatments with minimal side effects. The key trick? Show up with an empty bowel and a full bladder. All my appointments were early in the morning, so I’d wake around 4:30 a.m., make coffee, and write in my journal. Thankfully, I usually had a bowel movement before the 30-minute drive to Radiology. I’d drink water on the way and, more often than not, arrive ready for treatment. The only issue I have is I cannot hold it as long as you used too and if I fail to use the bathroom before bed I will on occasion wet the bed a little if I am very tired and sleeping heavy.
Lupron, on the other hand, was a whole different story. The real challenge came with the brain fog and emotional upheaval. I was the few that the libido revved up, but so did fantasies, (have yet to figure that one out) but the loss of self-awareness, and diminished executive function was real. The upside, I didn’t experience the depression many men report, just low emotional moments in the evening when emotions seemed to hijack everything. I struggled to think clearly or make basic decisions. I got to the point where I struggled to decide what to order off a six-page menu at a Mexican restaurant.
What’s scary is that you’re not always aware of what’s happening. Early on, I noticed short-term memory loss. Being in my late sixties, the fear of dementia was real. So I started keeping a daily journal. By my fourth Lupron injection, I couldn't remember my weekend by Tuesday. The journal helped me recognize that. Around day 75, my injections were every 3 months for two years, I began having occasional moments of clarity—that’s when I understood what brain fog really meant. But you only fully grasp the toll it’s taken about six months after your last shot. I am just now feeling like my normal self.
Two important things I wish I knew then that I know now:
• Bone density tests are crucial. I developed osteoporosis, discovered only after I shattered my tibia plateau stepping down from my RV. Recovery took six months to just get off crutches.
• Muscle atrophy is real. The real issue I think with ED is not the lack of interest in sex, it is the genital shrinkage that can and does happen if you simply give up having sex. Calais does help prevent that—but start early. It won’t reverse the damage if you wait too long.
Final thought. Stay active. For example I took up dance lessons. With brain fog and memory issues it can be challenging but it is worth the effort. You will loss muscle mass so work out at the gym, not to build but to help prevent as much decline as possible. My last injection was the first of December 2024 and last week woke with a slight erection. I find that encouraging at the age of 69.

And yes the hot flashes and hot sweets with drive you nuts.

Quick request for all contributors: Please offer whether you have had the radical prostatectomy and when. Some comments suggest that the therapies and treatments are being considered, or have been underway for quite a while, with your prostate "still intact" in your body. Some comments offer just enough information to suggest or obviate that the only way that info can be obtained, is through radical prostatectomy and a detailed pathology report. For example, I need to research whether ADT is given "only after" radical prostatectomy, or if it is an alternate treatment given to patients who elect "not" to have radical prostatectomy? And, some people speak of radiation. I know radiation is a (poor) choice vs radical prostatectomy, but that radiation is also done "post-prostatectomy" when there were surgical margins and not all cancerous prostate tissue was successfully removed. Thanks for offering the added clarity.

Orgovyx + radiation for my Gleason 7 N1M0 knocked me flat. I had every SE listed but one. Six weeks post radiation, some energy is returning. I'm 73, and the Rx is 24 mos. ADT. I'm trying to negotiate. PSA one month after radiation/5 mos. ADT, 0.01.

Seems like a lot of ADT for G7…why so much? IDC/cribriform?

4+3, N1M0 iliac nodes My oncologists disagree on the PET interpretation, so I get ADT without ARPI.

I had a radical Prostatectomy 15 years ago. 3.5 years later, it came back and I had salvage radiation. Many of us in here have had prostatectomies.

You’re understanding about how radiation works is it just not what the science has found. Whether you have radiation or surgery, the results are about the same. The side effects are different. If you have not seriously looked at radiation, you should. You don’t give any information about your Gleason score depending on what it is or what other issues you have maybe one of the other treatments will work for you. If your cancer has spread outside the prostate, they usually do radiation on the prostate and the spread.

ADT is given under both those conditions. If you have metastasis and had surgery and/or radiation Then ADT is the standard of care along with an ARSI Like Zytiga Or one of the lutamide’s. Depending how high the Gleeson score you may have ADT. If you’re a very low risk case with a Gleason 3+4 that you might be able to safely get away without ADT