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Gleason 9: ADT before radiation
Prostate Cancer | Last Active: May 14, 2023 | Replies (42)Comment receiving replies
I was diagnosed with a Gleason score of 6 in 2016 and participated in Active surveillance since then. During that time, I had a PSA every year and a multi parametric MRI. My yearly PSA jumped from 6 to 10 this year, and I had a biopsy and MRI. The MRI showed no tumors or enlarged lymph glands, but then the biopsy came back with multi Gleason 7 less than 30% and two Gleason 9 with one 20% and the other 50%. My prostate is 111 ml. With no visible tumors and a large prostate, can radiation be used? I am waiting for the relults of a bone scan.
Replies to "I was diagnosed with a Gleason score of 6 in 2016 and participated in Active surveillance..."
Some radiation patients are recommended to take androgen deprivation therapy such as Lupron, starting 2 months prior to treatment, and continuing for a total of 18 months. It drove my testosterone to zero in 3 months and PSA to 3, and then PSA to zero three months later. However, everyone hates the side effects of Lupron, myself included.
The claim by my docs for starting Lupron before radiation was that it made the cancer more susceptible to radiation. I found that a surprising claim, but a minor issue. More likely, it brings the growth of the cancer to a halt as you prepare for treatment.
The factors the docs are weighing include your age and general health. At 80 yrs last year, I chose radiation over surgery primarily based on side effect differences. Important for people our age. However, one factor I didn't include was lack of appreciation of the negative effects of ADT. Hopefully, they will decline when I stop. Radiation can of course be used and likely will be recommended as they did for me. My view at our stage of life is that radiation is the simplest solution to making it likely you will not develop clinical disease or die of prostate cancer.
sailorman2003: I had 10.2 psa last November. MRI done. Biopsy and Decipher test done to show aggressiveness level using biopsy material. Spaceoar done. Radiation using MRIdian viewray machine (VERY tight margins with built in MRI) to limit harm to healthy tissue. 5 Treatments starting in January this year. Finished on Febuary 14. So far, psa down to 4.6 as of a week ago. Limited side effects (restricted urine flow but better now). Did use Flomax. Mayo is GREAT! but to check out the MRIdian Viewray, get another opinion from Dr. Nagar at Cornell Weill Presbyterian New York City.
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I think the biopsy is telling you that there is cancer in the prostate.
Radiation worked for me . Lupron and 39 sessions of IMRT brought my PSA from 83 to 1.2 in 5 mos. Zytiga was added and PSA is now less than 0.1 or undetectable. I am 75 and side effects make me feel 85 but I'm WINNING. Lupron and Zytiga and FATIGUE to continue for another 18 mos.