44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?

Hi Dinu - I am reposting my reply down in the stream of replies since you wouldn’t likely “see” it because I didn’t reply directly to you, I replied to a question directed to me:

Sure. And I wouldn't disregard the comments provided here thoughtfully by rlpostrp arguing for surgical removal. They're a good argument for that approach. And in that context I should mention that I have AML (Acute Myeloid Leukemia) in remission after a bone marrow transplant Feb 2023. My immune system has not recovered yet, getting slowly better. One of the arguments for me personally to choose radiation over surgery was avoiding infection etc. My own Urologist who does many surgeries said I should go with radiation as did my bone marrow team after a two week consideration using me as a case study. Radiation isn't preferred for marrow transplant patients because of the proximity of one of the largest marrow factories and of the intestines. But they unanimously voted for radiation. They didn't say but I know that they also are aware that my now nearly famous resiliency during many kinds of Chemo and so on, reduced my remaining reservoir of resiliency. Surgery has quite a challenging recovery usually. That's Googlable. Much less (but having its own aspects) for radiation.

General arguments for the radiation approach include clinical trials that concluded the comparative results of surgery versus radiation are equal. But I digress.

YOUR QUESTION
I've been on this ADT cocktail for 6 weeks. The side effects which are intermittent, are four things: 1) fatigue, 2) nausea, 3) mental fog, and 4) hot flashes.

#1,2,3 I'm used to f pm my AML treatment and I am still taking a Chemo from that, Same symptoms except the flashes. The benefit is I know how to handle them. But the effects are additive to the symptoms I already had.. I have an occasional bad day when they hit me harder especially the nausea which is my least favorite. But most days I'm still doing my things, fewer due to fatigue and energy, but still doing them. That's the "ride" I mentioned. From what I see that others write, some experience these symptoms at a lesser level, or one or the other is more prominent. I don't mind the flashes at all, some people do. And so on. Hope that helps.

Hi everyone,

update on my case:
After 40 days on Bicalutamid 50mg, i was scheduled to get my first shot of Lupron (Trenantone 11,25mg 3-month depot). The day before the shot (01 Oct 2025), I got my PSA checked.
For those of you new to the trend, my initial PSA (mid August) was 180. Now it came back 33.
I did change my diet drastically (no red meat, no dairy, no sugars, no coffee). Introduced a lot of veggies (mostly consumed raw). I am drinking soy, almond, or oat milk. I have experienced a lot with various forms of tofu. I also found a bunch of vegan dairy alternatives. One of them was an imitation feta cheese, that i had to read the ingredient several times because I could not believe it was made of vegetables (contained cocos milk). I could not make the difference between it and the real feta.
Now two weeks after the shot, I am not seeing any side effects.
I am working out daily, using one of those free at-home work-out apps. It gives me each day a routine of 20 minutes, and even if I am in a pretty good shape, I still break out a sweat. I also walk on average 12000 steps per day.
My PSA will be checked monthly and if it drops significantly after the first 3 months, I will go get RARP.
Psychologically, I am doing great, and i am actually looking forward to surgery.
The idea is to just go about with my normal life (work and family) and not really bother too much with the PCa.

That is all for now. I will follow up next month when I will have my PSA checked again or if I start to deal with any side effects.

To all, stay positive and trust the science.

Hi everyone,

update on my case:
After 40 days on Bicalutamid 50mg, i was scheduled to get my first shot of Lupron (Trenantone 11,25mg 3-month depot). The day before the shot (01 Oct 2025), I got my PSA checked.
For those of you new to the trend, my initial PSA (mid August) was 180. Now it came back 33.
I did change my diet drastically (no red meat, no dairy, no sugars, no coffee). Introduced a lot of veggies (mostly consumed raw). I am drinking soy, almond, or oat milk. I have experienced a lot with various forms of tofu. I also found a bunch of vegan dairy alternatives. One of them was an imitation feta cheese, that i had to read the ingredient several times because I could not believe it was made of vegetables (contained cocos milk). I could not make the difference between it and the real feta.
Now two weeks after the shot, I am not seeing any side effects.
I am working out daily, using one of those free at-home work-out apps. It gives me each day a routine of 20 minutes, and even if I am in a pretty good shape, I still break out a sweat. I also walk on average 12000 steps per day.
My PSA will be checked monthly and if it drops significantly after the first 3 months, I will go get RARP.
Psychologically, I am doing great, and i am actually looking forward to surgery.
The idea is to just go about with my normal life (work and family) and not really bother too much with the PCa.

That is all for now. I will follow up next month when I will have my PSA checked again or if I start to deal with any side effects.

To all, stay positive and trust the science.

Hi to all in this beautiful gang,

UPDATE:
So as you all remember i started this challenge with a PSA of 180.
After 40 days on Bicalutamide 50mg, and the day before my Lupron 11.25g 3month-depot shot, i redid my PSA. I was down to 33.
Now I am off the Bicalutamide, and 30 days after the Lupron belly shot, took my PSA readings again:
- free PSA: 0.16ng/ml
- PSA: 4.41 ng/ml
- qPSA: 0.04%
- Testosterone: < 0.17nmol/l (< 4.9ng/Dl)

I am not sure if this is a good result or not (have not discussed the results with my doc yet) but I am pretty happy with the drop in PSA.
Besides the medication, which honestly saying, it has not exhibited any side effects so far, I am super stoked about my change in diet, which has also lead to an increase in energy, contrary to what one might believe based on my testosterone level.
Diet wise, I have dropped all that is sugar (with the exception of the natural sugar from the fruits I eat). I have eliminated all red meats (and I mean all). No more dairy (i found plenty of plant based substitutes). There are plenty of options in Soy, Almonds, Oat milks, as well as a peas based milk substitute. All of them of course without sugar. No alcohol, but that somewhat already happening before I got diagnosed.
I still eat meat (poultry and fish). Increased the intake of fruits and veggies (all in raw form) and I have to say that I become quite fond of raw broccoli :). Tofu has also become a main ingredient in my salads and some meat substitutes.
On top of that and I am tracking at least 12K steps per day, throughout my various daily activities.
I have also started a home work out program (20-30 minutes/day) with no equipment, just a mat, but when i was on vacation I substituted the mat with a beach towel.

That being said I will redo my PSA beginning of December and January, for my 2 and 3 month mark on Lupron. If the values continue to drop, which i am quite confident they will, I will redo my mpMRI and PSMA PET CT scan.
Based on the results of these two scans, I will then most likely schedule my RARP.

Overall, I am feeling really good both physically and mentally.

Feel free to share your opinions and thought on my progress.

The main thing is to stay focused and remain positive.

I know you all can do it.

Thank you for taking the time to read my update and I look forward to hearing from you all.

All the best,
Dinu

Hi to all in this beautiful gang,

UPDATE:
So as you all remember i started this challenge with a PSA of 180.
After 40 days on Bicalutamide 50mg, and the day before my Lupron 11.25g 3month-depot shot, i redid my PSA. I was down to 33.
Now I am off the Bicalutamide, and 30 days after the Lupron belly shot, took my PSA readings again:
- free PSA: 0.16ng/ml
- PSA: 4.41 ng/ml
- qPSA: 0.04%
- Testosterone: < 0.17nmol/l (< 4.9ng/Dl)

I am not sure if this is a good result or not (have not discussed the results with my doc yet) but I am pretty happy with the drop in PSA.
Besides the medication, which honestly saying, it has not exhibited any side effects so far, I am super stoked about my change in diet, which has also lead to an increase in energy, contrary to what one might believe based on my testosterone level.
Diet wise, I have dropped all that is sugar (with the exception of the natural sugar from the fruits I eat). I have eliminated all red meats (and I mean all). No more dairy (i found plenty of plant based substitutes). There are plenty of options in Soy, Almonds, Oat milks, as well as a peas based milk substitute. All of them of course without sugar. No alcohol, but that somewhat already happening before I got diagnosed.
I still eat meat (poultry and fish). Increased the intake of fruits and veggies (all in raw form) and I have to say that I become quite fond of raw broccoli :). Tofu has also become a main ingredient in my salads and some meat substitutes.
On top of that and I am tracking at least 12K steps per day, throughout my various daily activities.
I have also started a home work out program (20-30 minutes/day) with no equipment, just a mat, but when i was on vacation I substituted the mat with a beach towel.

That being said I will redo my PSA beginning of December and January, for my 2 and 3 month mark on Lupron. If the values continue to drop, which i am quite confident they will, I will redo my mpMRI and PSMA PET CT scan.
Based on the results of these two scans, I will then most likely schedule my RARP.

Overall, I am feeling really good both physically and mentally.

Feel free to share your opinions and thought on my progress.

The main thing is to stay focused and remain positive.

I know you all can do it.

Thank you for taking the time to read my update and I look forward to hearing from you all.

All the best,
Dinu

Hi to all in this beautiful gang,

UPDATE:
So as you all remember i started this challenge with a PSA of 180.
After 40 days on Bicalutamide 50mg, and the day before my Lupron 11.25g 3month-depot shot, i redid my PSA. I was down to 33.
Now I am off the Bicalutamide, and 30 days after the Lupron belly shot, took my PSA readings again:
- free PSA: 0.16ng/ml
- PSA: 4.41 ng/ml
- qPSA: 0.04%
- Testosterone: < 0.17nmol/l (< 4.9ng/Dl)

I am not sure if this is a good result or not (have not discussed the results with my doc yet) but I am pretty happy with the drop in PSA.
Besides the medication, which honestly saying, it has not exhibited any side effects so far, I am super stoked about my change in diet, which has also lead to an increase in energy, contrary to what one might believe based on my testosterone level.
Diet wise, I have dropped all that is sugar (with the exception of the natural sugar from the fruits I eat). I have eliminated all red meats (and I mean all). No more dairy (i found plenty of plant based substitutes). There are plenty of options in Soy, Almonds, Oat milks, as well as a peas based milk substitute. All of them of course without sugar. No alcohol, but that somewhat already happening before I got diagnosed.
I still eat meat (poultry and fish). Increased the intake of fruits and veggies (all in raw form) and I have to say that I become quite fond of raw broccoli :). Tofu has also become a main ingredient in my salads and some meat substitutes.
On top of that and I am tracking at least 12K steps per day, throughout my various daily activities.
I have also started a home work out program (20-30 minutes/day) with no equipment, just a mat, but when i was on vacation I substituted the mat with a beach towel.

That being said I will redo my PSA beginning of December and January, for my 2 and 3 month mark on Lupron. If the values continue to drop, which i am quite confident they will, I will redo my mpMRI and PSMA PET CT scan.
Based on the results of these two scans, I will then most likely schedule my RARP.

Overall, I am feeling really good both physically and mentally.

Feel free to share your opinions and thought on my progress.

The main thing is to stay focused and remain positive.

I know you all can do it.

Thank you for taking the time to read my update and I look forward to hearing from you all.

All the best,
Dinu

@dinu
Those are great numbers. I had a 138 PSA at diagnosis lowered to 80 with bicalutimide then rarp but still had a 9.5 six weeks after. Lupron and radiation got me to undetectable pretty quickly. Sounds like you are on an even better path to undetectable levels. Maybe even avoiding radiation. Great job on your diet, obviously helping. May have to think about it myself. Thanks for the update and good luck!! Brett