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Treatment options: radiation without ADT?
Prostate Cancer | Last Active: Sep 11 6:06am | Replies (66)Comment receiving replies
I appreciate any intel on my current situation. First some background then my question:
I am a 67 year old athletic and otherwise healthy cyclist - and eat an organic diet with regular exercise. Diagnosed in Sept 2024 with a Gleason of 4+3, 3+3, and 3+4. Urologist who did the biopsy called with the results and immediately suggested surgery. I needed more data. PSMA scan in November 2024 showed no cancer anywhere including the prostate. Hmm. PSA has never been above 1.7 the past 9 years.
My family history is what gets everyone's attention - paternal grandfather died of prostate cancer, middle brother also started with prostate cancer then metastasized and he passed at age 71. Oldest brother who is 75 has prostate cancer and has abandoned medical treatment after chemo kicked his ass.
Along with my diagnosis my wife of 22 years wanted a separation and is now asking for a divorce. It would have been nice to go through this with a partner yet not the case so I'm navigating as best I can. My children ( 34, 18, and an 11 year old daughter) are supportive as best they can.
I consulted with a different urologist about having 4 months to try a supplement and dietary protocol to see if there might be a change in my status. All this while navigating some heavy emotional challenges plus financial as I was not actively making money at the time and instead I was in the role of stay at home dad running the household the past 9 years. When my wife decided to separate our joint finances it forced me to start to make money again. I had been a successful builder a decade earlier so went back to work as a carpenter. I was pleased how my body responded to hard physical labor.
I decided surgery was out and am choosing SBRT radiation with one of the best docs in Denver. At the end of my 4 month reprieve a second biopsy revealed nothing had changed regarding my Gleason score and my PSA remained the same. So off to have a second PSMA which also revealed no cancer outside the prostate or in it. This has confounded my doc so now I am going for a PET scan next week. BTW my Decipher was high enough to be a concern which is why the PET scan was ordered.
Along with SBRT my doc is insisting that I use ADT in conjunction with radiation. So here's my question: I work 35-40 hours a week as a carpenter - hard physical labor, carrying building materials, up and down ladders and staging, climbing on roofs - all things I easily did in my 30's and 40's. I'm concerned that Orgovyx will take away my ability to earn a living as I am currently working on two large projects that would take me into the winter. When I press my doc about that I get some decent pushback that it would not be hitting the cancer as hard a I could be by using Orgovyx. Would SBRT alone be sufficient?
Any insight is much appreciated.
My five SBRT treatments are scheduled for the middle of October.
Thanks again!
Replies to "I appreciate any intel on my current situation. First some background then my question: I am..."
@coloradoboy
Wow, You are going through a lot. I had 30 rounds of proton radiation and no hormone treatment. Those who had hormone treatments would be best to help you with their experience with hormone treatments and the questions you had on that.
Just be aware we are all different in what we experience from hormone treatments, radiation treatments and surgery. What one will suffer with another won't.
From my R/Os the hormone treatments don't kill cancer cells. What they do is starve them on testortorone (spell). Thus gives what ever your treatments you get a better chance of success as the cancer is being starved from growing.
If your Decipher was high then you have a intermediate or high risk and that usually sees a urologist and/or R/O recommend hormone treatments. I was originally set to have hormone treatments with my radiation treatments but my Decipher came back low risk and they dropped the need for Decipher.
What you are having to go through at this stage of your life, going through divorce, and have prostate cancer can be overwhelming. Reach out to your health care providers for both medical and mental health. Us on MCC are here all the time to give you our experience.
Just know I have been through a couple of divorces with my last one over 40 years ago was horrible stress. I have been happily married since 2001. Having prostate cancer at 76 was hard enough without divorce and financials issues.
I wish I could give you my experience with hormone treatments but did not get them. I do know I had very mild side affects from radiation but it never affected my lifestyle.
Your story is an interesting one and I think you would get better replies if it was in a dedicated thread.
That said, very low PSA, pc in your history and a twice-confirmed 4+3 Gleason would indicate to me that it is serious. If you are super fit, 6 months of ADT seems to be quite doable just based on posts by folks on this forum who are physically active.
As you know, construction is both physically demanding, fairly high up on the list of hazardous occupations. As I aged, I became increasingly aware that my ability earn a living was predicated on not becoming injured because the old bod just doesn't rebound as fast as it used to, and accidents do happen on the job even to experienced workers in good shape. I opted to get a genreal contractors license. Being in control of the work I accept reduces the risk of injury, allows me to earn more money and gives me scheduling flexibility. While on ADT, particularly during the second year, the scheduling flexibility was a big help! Unless things have changed in Colorado, the licensing is a fairly simple process in most jurisdictions. The downside is that I end up needing to workout now as most of the work I accept is not nearly as physically demanding as the work I used to do.
I wish you well on your journey and hope that you will continue to post updates as learning from each other's experiencesis what makes MCC such a powerful forum.
Bll
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Not Everybody produces PSMA, So the pet scan may not show anything. The thing is your biopsy definitely shows cancer. People who have no PSMA frequently have very low PSA scores because they also don’t produce PSA either.. About 10% of the prostate cancer patients have this problem.
The highest Gleason score is what is counted by the doctors, Yours is a 4+3 (7). The lower numbers don’t really matter When it comes to treatment options,, but how much cancer is in the 3+4 is important.
You didn’t include the detailed biopsy information, That is really critical to tell you what the best options are. What percentage of four was found in the core that had 4+3 also, how much of it had cancer?. Same with the 3+4. Are there any other things in the biopsy that are dangerous to leave alone? Were any of the following found in the biopsy, intraductal, cribriform, Seminal vesicle invasion, EPE or ECE.
In some cases, an FDG scan will show cancer that doesn’t produce PSMA.
Yes, ADT may cause fatigue. I’ve been on it for nine years and never had the problem, but a lot of people do. The thing is, you can overcome the fatigue by exercise and being active, which you will be doing if you’re working as a carpenter. With a 4+3 ADT is really important for long-term progression free survival.