Treatment options: radiation without ADT?

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!

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!

I had a similar score plus IDC, cribriform and other negative factors. Opted for SBRT no ADT. Quoting MD “ I’m not recommending ADT because the probable side effects are not worth the possible benefits”. I appreciated the brute honesty from a very well respected MD while all others were pushing ADT.

How long ago did you have this treatment? ADT can prevent reoccurrence for a couple of years if you have a high Gleason score, especially.

Was this MD that told you that you didn’t need ADT a Genito urinary oncologist? Having only SBRT with all of things you mentioned almost guarantees you will have reoccurrences. Progression free survival is greatly extended by having ADT.

I had a similar score plus IDC, cribriform and other negative factors. Opted for SBRT no ADT. Quoting MD “ I’m not recommending ADT because the probable side effects are not worth the possible benefits”. I appreciated the brute honesty from a very well respected MD while all others were pushing ADT.

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!

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.

When I was in your position I asked to have the various treatment options and likely outcomes explained to me. I was given links to the NCCN Guidelines and recent studies supporting each of the treatment options available for someone my age in a similar physical condition/life expectancy having the same NCCN category/Gleason score and confounding risk factors (IDC, Cribriform, EPE and .52 Decipher score, in your case). This made it possible to evaluate, for each treatment option, the median time to biochemical recurrence, cancer specific mortality and overall survival data. I could then weigh potential short term side effects during and/or after each treatment option and compare it to life without short term side effects due to treatment, but a much shorter time to the side effects which would likely result from untreated biochemical recurrence or the treatment of biochemical recurrence.

I walked in your shoes nearly 4 years ago when diagnosed with Gleason 9, EPE and cribriform. It was a frightening time to have to reach decisions that would dictate the quality, potentially both short and long term, and duration of life. The multidiciplinary team of doctors I met with at Fred Hutch/UW in Seattle provided the studies, data and links I needed to reach my decision to have RT (I chose to have proton) with 2 years of lupron + abiraterone. I had side effects many of which lasted approximately a year after completing ADT, but they certainly weren't debilitating. I continued to work as a contractor and we hiked, xc skied, mountain biked and kayaked with friends through the two years of treatment, although somewhat less frequently.

In the absence of comorbidities that would complicate your treatment decision, I hope that you have the data the doctor used to reach the conclusion that "the probable side effects and not worth the potential benefits." It is your body, your life and your choice. I hope you will continue to post so we can all continue to learn from and support each other. Wishing you continued success and happiness on your PCa journey!
Bill

SBRT was only 6 weeks ago. Treated by former Chief Resident of Radiation Oncology Mayo. I’ve researched the heck out of this and fully understand the risk. SBRT was MRI guided also utilizing Barrigel which I’ve learned is far superior to the old Spaceor. Read everything written here by you and others regarding the challenges but ultimately decided my body my choice.