Gleason 9: ADT before radiation

We must be brothers. I too am 68 with Gleason 9 (local), Radical Prostatectomy, and 35 radiation treatments. I started Eligard just before radiation. I did Eligard for 18 months. My new onocologist recommends 6 months of Eligard rather than the historical 18 -24 months of Eligard. This protocol is possible with the release new PSMA scans.
So after the 6 months you monitor your PSA and testoserone every 2 months. Should you see your PSA increasing, then your onocologist runs a PSMA scan which shows any prostate cancer in your body and its location. The doctor can then target the cancer with radiation or surgery. The big advantage with this approach is that the hormone treatment is limited to 6 months. This limits the amount of nasty side effects of hormone treatments. The longer you do hormone treatment the less likely your testosterone will rebound. Good luck my brother and may your cure be in sight.

Talk about PMSA PET SCAN the urologist had one done prior RT and Eligard it was negative and the continuing treatment you just wrote is exactly what we were told just yesterday.. the radiologist wanted 2years Urologist is saying 1 and monitor with PSA & scans as needed..

I am 4+3...PSA 5.26, Biop/6 sites, on hit, 30%, grade group 3, 77 yrs old, excellent health, just did a work-mission trip overseas. Just had a CT & Bone, locally in Ashland WI...CT & Bone OK...during consult, Doc offered 20 treatment, one month photon program with MRI before. Also ADT/Luproloid (sp).
I am pretty confident with this guy & pre-registered at Mayo (6 weeks from now) for a 'second opinion'...im MY mind, I believe I am dealing with a high certanity here without the additional Mayo...BUT going to Mayo etc is not a hassle for me...I just see OK odds with the above inital assessment. What do my brothers think?
Rex/ed

Suggest getting the 2nd opinion and then decide.

The question is what will a second opinion produce in choices? If the 2nd opinion is to undergo a PSMA PET, and, if done and it shows no positives outside the prostate, that might favor surgery, but I actually don't think your decision changes by much.

A positive PSMA PET would, I imagine, rule out radical surgery. If a negative PSMA PET? Note: I do not know the detection limit of PSMA PET, so a negative is a good thing but does not rule out spread beyond the prostate. You will still be stuck with choosing radiation or surgery. If surgery, then you are going for a "cure", because if the disease is confined to the prostate, if you cut it out and put it in a jar, you've likely got a cure. Having said that, I think going for a cure is a better choice for a younger man. At your age, they likely will recommend radiation. My situation (3 yrs older) is similar to you in age, health, PSA, and pathology. I chose radiation six months ago based on my estimate of side effects, quality or life, and the reality of actuarial tables.

That's one opinion. What do others think?

That's a well reasoned approach and one I plane to follow unless some new evidence comes to light. There are still choices and I am curious what you decided:
ADT yes or no and how long if yes?
What type of radiation? Proton Beam Therapy? Stereotactic radio surgery?
From what I read about ADT, it would turn me from a very active 83 year old, to an old man in a year. What do you think?

That last question is the perfect - and most difficult - question, and best encapsulates the dilemma of so many men..

Last week, in preparation for my quarterly video visit with my UCLA oncologist, I asked him in advance to be prepared to answer a couple of questions I would ask him. A key one was: "what is the survival data for patients comparing PCa treatment with/without Lupron". I then asked that question in the Zoom meeting. He successfully elided the question. Same question on my current 9 months on Lupron, versus staying on a scheduled 18 months. He offered to take me off after 12 months. I ask for data to make an informed decision; he offers me nothing.

We both have to accept that we have outlived most of our compatriots, and so focus (as you are), on quality of life issues in the time remaining. That's what I did in choosing radiation. I just hadn't fully appreciated the side effects of Lupron.

As you surmise from this complaint, Lupron ain't fun. Actually, as most will tell you, it's shitty. Example: I went from able to do as many pushups as I cared to, to barely able to do three! I was in great shape. Now, I'm ten pounds heavier, and in all the wrong places. So, I wanted to know the pros and cons, and length of time, and got no answer, so must proceed on my own. Perhaps you can learn more than I did. My guess: if one were to assume less than 10 more years of life, perhaps no Lupron would be reasonable decision,

BTW. There are some other choices besides Lupron that might be better. I did not think to explore them. But, that again gets back to the basic issue: the docs should give us more information to make informed decisions. I feel I'm getting some of the best information by reading about the decisions and paths taken by others sharing our journey.

My radiation (I think it was "View-ray" one of three that UCLA offers) was coupled to realtime MRI with overlapping images coupled to computer control of the radiation margins. This allows superior control to minimize extra-prostatic damage. I assume this is gamma radiation. I assume this is similar to the "cyber knife" I've seen referred to.

Note: I underwent "hydrogel" placement to separate the prostate radiation target from my colon, which it was pressed up against. I credit it to my lack of any side effects from the radiation.

This is all new to me, and I am still in a bit of shock. I have a long lived family; my mother lived to 97 and my father's brother to 100. At the moment, I feel a few years of high quality is better than 12 years as an old man. With no data, it's impossible to make an informed decision. My guess, is that 3 months on ADT is all I will do unless there is hard data to indicate a significant improvement in the prognosis. One choice, made in total ignorance, seems to be possible to get the PSMA scan and zap all the cancer with proton beam radiation. Follow that with regular PSA tests and further treatment if it rises. As I said, these thoughts are without any sound data to back them up.

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.

I've had a similar experience to @drj . Except my Radiation Oncologist did answer the question of numbers using ADT vs not using it.

My history is a little different though, RP followed by "biochemical recurrence", maybe? My PSA was high enough second time around to meet the clinical definition of BCR but we decided to be aggressive and treat with radiation and ADT. I'm on Orgovyx which is a newer oral version. I've never taken Lupron so I can't compare it, but, it stinks as well. All the same side effects. I've been on it for a full year. I'm 61.

My RO told me that, in my situation, ADT provided 3%-5% better outcomes. That's pretty much a quote. You'll be able to locate other numbers in various studies. My surgeon who is sort of the "quarterback" for the treatment wants me on it for 2 years. The RO (same practice) says 6 mos is plenty. The RO essentially says the reason for the ADT during radiation is that it weakens the cancer so that the radiation is more effective. I asked if it actually killed cancer cells and he tells me "no."

I research as best as I can, I can't find anything that claims ADT kills cancer cells.
Harvard Medical "Hormone therapy, formally known as androgen deprivation therapy (ADT), deprives prostate cancer cells of testosterone, which they need in order to grow and spread."

Next appointment at the surgeon, (quarterly post PSA test visit) I ask why two years? He tells me we want to kill any cancer cells that might be left in my body. Ya can't make this stuff up. These guys are all in the same medical group.

My next blood test is going to be a full panel test, we'll see what else the ADT is doing to my system and likely make a decision then. If it isn't doing too much damage to liver, sugar etc.. I may gut it out.

I have two friends who had PCa years ago, had radiation without ADT and are doing fine. Who can tell? One was a Gleason 6 the other 7 like myself.

My feeble brain at this point goes to this....
My current psa is