Gleason 9: ADT before radiation
I have been on active surveillance since 2016. PSA jumped from 6 to 10 and biopsy Gleason 9. Doc ordered Luperon and radiation. Does it pay to start the Luperon before radiation? I am 83, does ADT work for people my age?
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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.
The way I understand it, ADT essentially drastically lowers your testosterone production thereby making the cancer cells weaker and reproducing at a much slower rate (if at all). This weakens the cancer for the radiation treatment which we hope will kill it. So for my money, yes, starting before would make sense. I started about two weeks before radiation.
Does it work for people your age? I would think it would work for most men I don't believe age is that much of a factor. You're trying to get those testosterone numbers very low. You will read that there are some folks who this doesn't work for, but I think it's somewhat rare.
In the paragraph below, this is not how testosterone is measured, I'm using this scale for comparison based on the way I'm perceiving the question.
Say the scale is 1-10, a 20 year old being ten. It seems to me your asking this because the average 83 year old might normally be around 5 anyway. The docs are trying to get it to 1 or less.
Hopefully I understood the question!
Best of Luck to you!
Thank you for the comment
My Gleason was 9 and I am75. UCLA doctors wanted me to do 6 months of lupron plus Erleada then surgery and my surgeon said that this made the cancer soft ( before it was hard ) and he had a better chance of getting it all. Then after surgery 6 more months of these meds. I think that this treatment was the best for me and I am wishing you and all of the rest of the guys on this site the best.
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.
@sailorman2003, I hope you don't mind, but I moved the 2 discussions you started into one to bring everyone into the same place, including the helpful replies from @spryguy @hbp and @web265.
No problem. Thank you for cleaning that up. I'm new here
Don’t mind at all. Thanks for the good work
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.
Then 2 mos Eligard prior
Then 39 salvage radiation
Continue Eligard 18-24 months
From everything I read several studies showed longer remission times with the ADT treatment started prior and continued 18-24 months