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Gleason 9: ADT before radiation

Posted by sailorman2003 @sailorman2003, Mar 4, 2023

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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pianoman | @philipbrachko | May 14, 2023
In reply to @slowandfidgety "I'm 69. diagnosed with prostate cancer in Feb 2023. My PSA was holding about 4 early..." + (show)
@slowandfidgety

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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Ask your doctor what is the statistical probability of a favorable outcome with radiation. Favorable being, no bad side effects and the cancer not coming back. All patients are different and all PC is different. According to my RAD therapist. There is a 10% chance of a bad side effect, and 50% chance it will come back. I've been on ADT for 8 months. Great results. Testosterone and PSA are undetectable. My RAD doc still wants to do radiation and them come back to ADT if I need it. I have chosen to stay on ADT until there is something he can see to radiate.

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mowind | @mowind | May 14, 2023

I’m 72, I was diagnosed with Waldenstrom’s Macroglobulinemia (malignant lymphoplasmacitic lymphoma) a year ago. During the diagnosis of my blood cancer a PET/CT scan looking for lymph node and/or bone involvement found none, but to my surprise there was uptake into my prostate. The surprise was because a couple of weeks earlier my annual visit with my urologist ended with “all good, see you next year.” In other words, no anomalies in my PSA or DRE. Subsequent MRI (Pi-Rads 4) and biopsy (Gleason 5+4=9) put me in the high risk category. In September of 2022 I began 6 months of chemotherapy (for the lymphoma) and ADT (to hold the prostate cancer at bay until I completed the chemo). I finished the chemo in February and a week later began 20 rounds of proton beam therapy at Mayo Phoenix. I received another 6-month dose of ADT a week after completing radiation, with two more shots scheduled in September of this year and March of next year. Since the ADT shots are 6-month doses, I figure I’ll have it in my system until early 2025. So far all my various treatments appear to be working, and the side effects have been tolerable. With respect to the ADT, I definitely wanted it when I started last September since I needed to get through the lymphoma treatment (chemo) before the prostate treatment (radiation) could begin. Before the ADT began I was experiencing ED, but Viagra and Cialis helped with that. Now they’re pointless because my libido is shot, but I’m counting on (or should I say hoping that) my libido bounces back after my ADT treatment ends. I guess I’ll see…

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