Gleason 9: ADT before radiation

@drj
I have no more information on the 3%-5% claim made by my Radiation Oncologist. He pretty much answered EVERY question I asked him with a statistic, I had written them down and my wife was in the room and confirmed it. Where he got this number, I have no idea.

Your doc may be eluding the question because he believes in the drugs and believes that they'll help you even though the statistics don't support it as strongly as he believes it. Saying it "helps everyone", I'd say it's honest, it's weakening the cancer cells so slowing growth and maybe buying time. This is likely his belief. My radiation oncologist was somewhat ambivalent about me taking the drug.

My doc (RO) claims ADT drugs like Lupron, Orgovyx etc.. weaken the cancer cells by denying them food (testosterone) so that they can't grow as normal and are in a weakened condition. The rationale for this around the time of radiation is that the weakened cells are likely more effectively damaged by the radiation. (which also doesn't actually kill those cells they tell me, it alters the dna in the cell so that when it splits it produces two dead cells instead of 2 viable cancer cells.

I'm beginning to believe that my surgeon, the dr who wants me to continue the drugs, is possibly doing this for my psychological benefit, by keeping my PSA so low through the use of the drug, I'll feel better and more like I may be cured for a longer period of time. Or, perhaps he feels he's buying me time for something better to come along treatment wise. My feeling is, I won't really know anything until I've been off the ADT meds for a while and we see if the PSA stays relatively low.

Now...since we've both already taken the drug (not sure what other treatments you've been subject to at this point) it's a bit moot. The real question is "How long?" You will find doctors with differing opinions on this anywhere from 4 mos to 3 years. I'm at a year now and the surgeon wants me to keep at it another year.

I honestly don't think there is enough research in the hormone therapy field at this point to get a definitive answer. In addition, everyone's illness seems to really take it's own path, it's very difficult to have consistent disease to study. There are just too many variables in aggressiveness, status of the disease when diagnosed etc..

I think you have to make a decision for yourself, as best as you can, knowing all the variables that you can know for yourself. I plan to look at my next full panel blood test and see if there are a lot of negatives that weren't there prior to the drug. If there are, I may stop. If not, I may gut out the next year.

vjlvpjalways: if that question is for me...it was to cure and my RO said that was the intent and she said was the result. We will see. Maybe but no guarantees in life. Free of but not from cancer. The good news is the PSA is down.

I just looked at a new study reported in https://www.nejm.org/doi/10.1056/NEJMoa2214122. As I understand it, the results are out past 15 years, and most of us only have about 20-25 years all-cause life expectancy. It's very hard to know how to trade the potential risks for "better" years vs "more" years.
Interestingly, given that over all mortality at 15 years was not greatly affected, the three secondary outcomes included metastasis, ADT (therapies like lupron,) and BCR (biochemical recurrence as measured by PSA). I think this indicates that caregivers view those with any of these as more likely, though they're not sure by how much, to die from PCa.
So would you trade 5 years with ADT for 3 years without? (Assuming you actually could, which we can't know.)

After two months on Eligard, my blood sugar went from 65 to 148. It seems the cure is at least as bad as the disease, or worse.
There are no studies, yet, that show the impact of a PSMA scan on longevity. But it seems logical that with a highly sensitive detection mechanism and highly targeted radiation, survival rates will improve dramatically even without ADT.

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.

I was Gleason 9. I trust hormone therapy despite the side-effects. Along with radiation and Xtandi has done wonders for me. It drops testosterone levels which is vital to control cancer. But every case is different. I took hormone therapy for a long time (3 and a half years) but I would take it again if I needed.

Thanks for saying hormone therapy can be trusted. It does agree with what docs say. If it comes down to it, it will be a tough decision for me.

It may work. I am Gleason 9. Had positive LN in pelvic region. Started Eligard and ADT. PSA went down from 13.4 to 0.1 in three months. Lymph nodes were gone (as per PET Scan) before I finished the 39 sessions of radiation.

I agree with Cesar and Slowan…. I had ADT and Erleada for 13 months, manageable side effects and it worked. I probably will go on it again as my cancer advances. For now the cancer is asleep and I don’t want to wake it up!

Love it!! Really true and funny. Best for you my friend.