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Trying to choose between radiation and surgery
Diagnosed 7/15/26, 2 of 12 cores 3+4 on both 20% and 30%involvement t1c, have oncologist appointment on 8/20 and Urology surgeon on 9/28, asked my main urologist for a decipher test hopefully it reaches the oncologist before the appointment. If it comes in lower considering optional treatments without adt but if not probably will proceed to nerve sparing surgery also if that was the case I was hoping I could get a lower groin hernia fixed at the same time.
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There's definitely arguments on both sides, but I will see how my decipher score turns out and go from there.
I have an appointment at ohsu on 8/20. Ideally would like to do radiation without adt.
@rickdent I have been there. At 77 I don't think you'll have a surgery. Gleason 8+8 is high and your medical team, I guess, will try to block the testosterone to slow down the cancer. Lupron has some side effects but it is is the most efficient known to block the levels of testosterone.
If this helps you, I have the surgery 9/19/2015. The cancer came back on 8/17.
Since then, I have been with cancer; stage 4 since 6/2019. I am 80 now.
Good luck
That's not me 2 out 12 cores Gleason 3+4 t1c psa 5 , .156 psa density waiting for decipher score on up coming oncologist app excellent health otherwise age 69.
@jeffmarc
Thank you so much for your generous and rapid response.
Have you been on ADT continually?
@amota
Thank you so much for your response. May I ask if you have been on Lupron continually since your recurrence?
@rickdent
I have been on ADT since 04/2017. I did stop in 2024 for eight months, My oncologist and I both figured my Testosterone would never come back. In eight months, it hit 50. My oncologist had me go right back on so I’ve essentially been on it for almost 9 years now.
I was just diagnosed with 3+4 2 out if 12 cores haven't started treatment
yet see oncologist on 8/20
@rickdent Similar situation at 76 YO. Doctors do not recommend and really didn't want to discuss. I spent way too much time researching the surgical option because articles, including those from leading sources, rarely mention age related treatment limitations.
@rickdent Did you have a PSMA PET scan? At a Gleason 8 there is a high probability of micro metastasis in the prostate bed which would give you a recurrence after surgery. The Decipher is also not good. Recovery is also worse from surgery the older you get. Many surgeons will not even consider a patient at 77. For all those reasons radiation with ADT was probably recommended. If there are no metastasis on the PSMA PET the ADT should be 6-12 months. If Orgovyx is covered it is usually easier than Lupron on the body. Has an ARSI been discussed in addition to Lupron? All of this depends on what was found in the biopsy. How many cores were positive? What percentage of these cores? were there other aggressive conditions found?