ADT or no ADT? What should I ask my Oncolgist?

Actually, a Lupron shot is not called for when you have a 3+4. The NCCN sets guidelines for this, and that is not part of the guidelines unless there are other aggressive issues.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive. If any of these things were filed, the doctor may say that is the reason you need Lupron.

You could get a decipher test and if it showed very low chance of reoccurrence they could avoid the Lupron shot.

You have a very slow growing cancer, so don’t be overly anxious to get it out right away. You have plenty of time to decide and get answers. Prostate cancer is pretty much a chronic disease, not a fatal disease.

How many cores did they take and how many of them had 3+4. What percentage of four was found?

A 6 Month Lupron shot is really not a big deal. My brother had it when he had a 4+3 at 77. He had some hot flashes, but that was about it. They did last for about six months after the six months shot wore off. Most of the other side effects from Lupron are not too bad when you’re only on it that short a time. I had a six month Lupron shot when I was 64 just before having eight weeks of radiation. I didn’t even notice the shot or side effects.

When I went on it full-time 2 1/2 years later then I really noticed it lots of hot flashes.

If Im reading it correctly, it looks like 17 cores. One core was 3+4 @ 20%. (4 with 3+3). I will find out more when I meet with the oncologist but the lupron effects are concerning. (Heard some bad case scenarios)

relev1, you might ask about Orgovyx. It's a daily pill. Jeff has the better answer.

@rclev1
Definitely a very mild case. You probably do want to trade it instead of going on active surveillance. Radiation would work with such an small amount of the cancer.

As @gently mentions. Ask for Orgovyx instead of Lupron. Most people have fewer side effects, When you stop taking it, your testosterone comes back much quicker.

It’s unlikely ADT would be called for with such a minor case, if the doctor insists that would be better for you?.

I am really new at this, but 3+4 on one and I don't think they usually do anything but watch 3+3?? Jeff had some good questions that need answered and maybe further testing.
Is a 3+3 even considered for treatment or just monitoring, I don't know just asking other much more knowledgeable than myself.

Ask what benefit is expected from ADT for 3+4 (favorable intermediate) when several studies show no benefit from ADT for preventing distant metastasis, reducing mortality, etc. until disease is 4+3 or higher (unfavorable intermediate or advanced).

The older you are the more likely that testosterone will be severely reduced from pre-ADT levels even with short term ADT. This is true with Orgovyx and even worse with Lupron / Eligard (same active ingredient, different injection site).

@rclev1 There is no reason you can’t get Orgovyx unless you have an insurance plan that won’t cover it. Medicare usually does but copays can be high (until you hit your $2000).
Or, if your RO is simply an oldtimer who simply uses what he/she has used for years.
Phil

@heavyphil Yes. ROs are like anybody else, doing what they know and reluctant to change. Second opinions are important. I found that out when my RO, otherwise ready to go with a round of radiation based on what he saw from a PET scan, informed me that the machine he wanted to put me on was down, and maybe I should look elsewhere for radiation. I did, and I'm now going through a far more careful process with the team at Johns Hopkins, who saw that radiation to one area carried significant risk of organ damage. That could have been me. The drugs we're all on put PC to sleep, so we have the time to be cautious about treatment. Get the second opinion.