So, with that clinical data, no treatment may be a consideration. PSA is a data point in the decision to treat or not but it is not the prostate cancer and that is what we treat.

GS 6 for the most part is not considered moderate or high risk and may be actively monitored but not treated unless the clinical data indicates a change while monitoring- that could be a subsequent biopsy, preferably not a TRUS but a MRI guided one, imaging results or changes in PSA.

The general rule of thumb for PSADT and PSAV is:
6 months but less than 12 months, treat if other clinical data supports.
> 12 months, continue active surveillance.

Interesting that his PSA is 16.9, when you say has not spread or metastasized, I understand that he has had whole body bone scan imaging and it shows no evidence of PCa anywhere. Since imaging today can detect PCa at levels as low as .2 (my recurrence was located at .7_

At age 79, it may very well be he in the end, he dies not of PCa but of something else. Not trying to be morbid but if his GS is 6 and it could be 8-10 years before there is any metastasis and even then that could be treated, well...

Another question for his medical team may be what are they thinking, a lifetime of ADT or for a definitive period? If the former, fire them. If the latter, define for how long, what is the criteria for stopping, how will they monitor when they do stop, what might the criteria for going back on treatment...

With the clinical data you describe, other than the PSA, none of the clinical data indicates treatment - GS, Imaging, health, PSADT and PSAV. In this case, the "cure," Lupron, is worse than the disease is.

Kevin

Kevin
Given his age and the likelihood of some CV disease, there is an alternative to Lupron, Relugolix which works by blocking the pituitary gland from making hormones that stimulate the testes to make testosterone – thereby lowering a man’s testosterone levels. Instead of an injection, the patient takes an oral tablet once daily, at approximately the same time each day, with or without food. Side effects of ADT can include weight gain, increase in cholesterol levels, and increased risk for heart attack. A striking finding in the clinical trial for this agent was a 54% decrease in major cardiac events (such as heart attack and stroke) in the patients taking relugolix vs leuprolide. It also does not have the flare Lupron does, faster to castration, higher sustained castration and quicker recovery of T after stopping.