← Return to 44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?

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Bill, thank you for your reply. I’m swaying towards the radiation. As it seems with Gleeson, nine the chances of your knee radiation and ADT after surgery are very probable. I’ve been giving two different options. One is SBRT 5 round an and six months of ADT combining Orgovyx,Zytiga & Prednisone. The other opinion, I got said the best way is more tried and true doing ISMRT 20 rounds and then 18 months of Orgovyx. I hear so many stories of the bad side effects of the medicine. I’m tending to go towards the six months of ADT, do not be on it for 18 months , but in the back of my head, I keep thinking the cure may be better with the trideand true 18 months with your research which way did it point?
Your researchedopinion is greatly appreciated
Steven

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Replies to "Bill, thank you for your reply. I’m swaying towards the radiation. As it seems with Gleeson,..."

Hi Steven,
If I were in your position, I would first determine what risk group I would be in according to the NCCN Guidelines Risk Stratification definitions because that is what would inform me to how the best oncology doctors in the country concur that I should be treated to minimize the chance of cancer recurrence as well as both short and long term side effects.

In order to know what risk group you are in, you would need to enter the information from you biopsy pathology report showing the number of cores taken, the Gleason grade of the tumor found in each one and whether the cribriform was large, small or intraductal (IDC). You would also need to share what your last PSA test result was that prompted you to get a biopsy.

My preference for treatment options would almost always be one stipulated by the NCCN Guidelines (NCCN.org). The picture below shows the RT treatment guidelines for both High Risk and Very High Risk patients. In the discussion section I do not see that they reduce the time on ADT for SBRT nor do I see the addition of abiraterone for High Risk Patients, only very high risk patients. So I would want my doctor to specify which risk group I was in and what characteristics placed me there and then follow the NCCN guidelines for the RT the ADT agents prescribed and the duration of the treatment. If treatment was to deviate from the NCCN guidelines, I would want to see read and understand the study and its results before agreeing to a different treatment plan. I hope this helps.
Bill