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About to start treatment with Proton, question about ADT
Prostate Cancer | Last Active: Nov 26, 2025 | Replies (15)Comment receiving replies
@brianjarvis Thanks so much for your detailed response!
>Did the MRI report mention the terms extracapsular extension, seminal vesicle invasion, or perineural invasion?
> Did you get a 2nd opinion on the MRI scan?
"No evidence of extra-prostatic disease or pelvic lymphadenopathy" and no, no 2nd opinion.
> What % were “4” and what % were “3”?
> Did the biopsy report mention the terms cribriform pattern or intraductal carcinoma?
> Did you get a 2nd opinion on the biopsy tissues?
1 sample was Gleason 6 in 1 of 1 core, 13%, 1 was Gleason 7 in 1 of 1 core, 67%. The 4 was 20% cribiform. No 2nd opinion.
> what were the SUVmax scores mentioned in the PSMA PET scan report?
SUV of 3.7
> As for the use of ADT, NCCN guidelines do not recommend ADT for a 3+4=7 (see attached NCCN guidelines) unless there are other risk factors.
That's big. I'm really leaning toward dropping out of the study if I draw ADT.
Regardless, I definitely should start exercising- I am very sedentary currently, so any exercise would be beneficial.
Replies to "@brianjarvis Thanks so much for your detailed response! >Did the MRI report mention the terms extracapsular..."
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@mcan56 It’s the totality of your numbers and the (lack of) other risk factors that should determine your choice of treatments.
Your Gleason 7(3+4) only having 20% of “4” is good.
Regarding your SUVmax of 3.7 —> You need to know the PSMA SUVmax values of your blood, liver, and parotid (or lacrimal) glands, in order to compare the SUVmax scores of those cancerous areas to. Those should all be in the PSMA PET scan report. If they aren’t, ask the doctor for them.
If all you have is a low-grade 7(3+4), then ADT is not recommended for these favorable intermediate prostate cancers. In fact, there’s a 2023 study about this (https://youtu.be/cyY0nHXvzGc)
(With my 7(3+4), I was not planning on using ADT. However, prior to the start of my 28 proton radiation treatments a 2nd opinion upgraded the Gleason to 7(4+3). Not knowing which was “right” - the 3+4 or the 4+3 (since they were both educated, experienced opinions) - I chose to be treated using the higher Gleason score. So we simply added 6 months (two 3-month injections) of Eligard to my treatment regimen.)