Treatment options: radiation without ADT?

@billkmed
Sounds like you have an experienced and excellent R/O.

When we have prostate cancer the bottom line is you do what is best for you. What is best for someone else does not mean best for you. When you research and have an experience R/O and you trust that medical provider that is your choice. You are correct it is your body your choice.

You did not mentioned Decipher test or PSMA. Were they done? They are very precise test to help you and your doctor know more accurately risks and status of your cancer.

I had 30 rounds of Proton Radiation with no hormone treatments. I was originally going to have hormone treatments but my Decipher came back low risk and hormone treatment recommendation was removed. I did go through a second opinion and got same diagnosis and treatment.

The decision to have hormone treatment is a personal one to make for yourself with consultation with your doctors. I was told by my Mayo R/O the increase in risks if I did not have hormone treatment was around 20% higher with an intermediate risk. That R/O said it is your decision. As I mentioned the hormone treatment recommendation was removed after Decipher test.

Hormone treatments don't kill (Mayo and UFHPTI R/Os) prostate cancer. What they do is rob the prostate cancer of testostorone which feeds the prostate cancer. Thus it retards the growth which allows the radiation or other treatments time to treat disease that is being kept at bay by the hormone treatments. If you have surgery it will help keep in from getting a tumor larger or help retard spreading until your surgery is done. Note I said help.

I am not familiar with Barrigel but you posted far superior than Space/Oar. I had Space/Oar to help move colon away from prostate. My Mayo PCP said studies are underway to see if having the Space/Oar provided significantly additional help with lessoning side affects of radiation or not significant enough to justify the procedure.

I was gald to do it as I wanted to do everything I could to lesson side affects of radiation. That is why I chose proton over photon. They both have the same successful outcomes of treatments. It was the possible benefit of lessoning of damage of radiation to surrounding organs and tissues is what I wanted.

Good luck on your journey.

Pet scan was OK and intermediate on decipher. I feel I was fully informed with all questions answered (and I had a lot of them). In fact, most of them came from this group of highly informed & inquisitive gentlemen. Also, it appears I fall into the smaller group of men here who have stated their acceptance of the fact that recurrence is very much a possibility considering my diagnoses and choice of treatment but I’m betting it will not be the cause of death.

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!

As my RO said to me regarding augmenting IMRT + HDR with ADT:

"if I were you, I would go on the Orgovyx ADT.....with only a six month regimen you should not realize many of the more severe side effects".

He was right.