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Gleason 9: ADT before radiation
Prostate Cancer | Last Active: May 14, 2023 | Replies (42)Comment receiving replies
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
Replies to "I've had a similar experience to @drj . Except my Radiation Oncologist did answer the question..."
web265,
3%-5% is statistically irrelevant so ignore that data.
You won't find that ADT kills cancer cells because it doesn't. ADT reduces testosterone to zilch. Testosterone fuels our prostate cancer thus you remove the fuel from the fire. I was a Gleason 10 so I took everything they threw at me. Yes, Lupron messed me up bad. Walking is difficult. I'm on Physical Therapy now and last week I fell and badly injured my leg which became infected. Just lovely!! If you can avoid Lupron I would give that serious consideration.
I've been trying to find criteria to decide when to stop Lupron. I'm finishing 12 months, and wondering whether the side effects of Lupron are justified by the claimed improved outcomes. Myself, I've found them devastating.
I've asked my oncologist three different times the following question: at some time, someone must have compared PCA patients treated with Lupron versus those who were not. How did the two groups compare? In other words, what percent had outcomes improved by Lupron. He has always elided the question (e.g. "everyone benefits"). It must have some valued benefits for many patients. I would like know the frequency and decide for myself what risks I am taking by dropping this therapy. As of now, I feel like a dead man walking.
I would like to have some detail on a claim of 3-5 % improvement. Surely that cannot mean 95% show no improvement in outcomes. Do you know more?
Can anyone clarify this, or explain my oncologist's non -answer?
I'm 69. diagnosed with prostate cancer in Feb 2023. My PSA was holding about 4 early in 2022 but had risen to 7.2 late in Nov 2022. had the DRE, felt firm. Insisted on an MRI in Jan 2023 before biopsy. It came back with a significant lesion and a PIRADS-5 indication supposedly all inside the prostate. Had the 8 targeted biopsies and 12 random biopsies; 12 of 20 were positive. Of the 12, six were 3+3, and six were 3+4. Based on the 3+4, and the high quantity of 4, I was given a t2c grade of cancer and an unfavorable grading.
While all this was going on, I was researching whether surgery or radiation was best with a wary eye on hormone therapy.
I talked with the urologist who kept throwing the surgery option at me. I then insisted on a visit with the radiation oncologist who said either radiation or surgery resulted in equal results. The radiation oncologist recommended a bone scan and CAT scan for any bone lesions that may exist and were missed earlier. There was one on a rib, though I had it since 2014 and it had not grown any (hmmmm).
He did say he would send my biopsies to Prolaris for review. Prolaris came back with a radiation only recommendation though it had a borderline hormone therapy option. Of all the research I did and conversation with a friend who had surgery, radiation, and hormone therapy, I said there would have to be a hard conversation with medical experts on hormone therapy usage for me if it came down to it for the same reasons you all have indicated.
I started daily radiation treatments (39 of them) on Apr 24, 2023. So far, the only side effects have been some infrequent diarrhea that may be caused by my diet or anxiety. I did the Space Oar gel insert before the radiation started. I was pretty adamant about no hormone therapy since it was not curative, only palliative treatment, or what medical folks here have said, delaying. HOWEVER, I did tell the radiation oncologist that if push came to shove, I would go along with his recommendation regarding hormone therapy. So far, no recommendation yet. I will deal with that later.
The bone scan finding still is in the back of my mind, one lesion on a rib.
This is one of those life's interesting journeys. I did have colon cancer in 2011; surgery and chemo which thoroughly sucked.
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I have the same concerns as it seems like 18 months to 24 months is just standard for all. I have also read a study that utilized doing ADT for 6months with the radiation treatments, then go off and watch the PSA and then if needed go back on for 6 months and repreat.