ADT for several months before Radical Prostatectomy

@jeffmarc @kujhawk1978 thank you both for responding. You have given so many of us great advice into treatment options . I can attest to that. Thank you . I’ll post when a decision is made .

This may brake a few minutes to truly understand but may be useful
https://www.urotoday.com/conference-highlights/apccc-diagnostics-2025/158641-apccc-diagnostics-2025-who-needs-additional-imaging-for-prostate-cancer-staging.html?utm_source=newsletter_13925&utm_medium=email&utm_campaign=apccc-diagnostics-meeting-diagnosing-staging-prostate-cancer

@kujhawk1978 i got it thank you. I had MRI with contrast, bone scan and PetPsma… no metastatic disease. All localized.

My condition was similar to yours, GS 4+5, seminal vesicle invasion. A recent MRI measured the prostate at 106cc. Since my surgery couldn't be scheduled early enough, ADT (Lupron Depot) was administered at my first meeting with the surgeon. Surgery was my first choice after hearing the biopsy results. The ADT was meant to slow the cancer and to shrink the prostate to a more reasonable size for da Vinci robotic surgery.
Three months later (Nov. 25, 2024) surgery was fully successful and 27 lymph nodes were pulled, 8 with tumors. PSMA-PET did not show these external cancers. The prostate still measured a hefty 99cc. There was a positive margin, GS 4, < 3mm, adjacent to the left seminal vesicle.
Almost 28 weeks after the Lupron injection (22.5mg, for 12 weeks 'effectiveness'), I am still having hot flashes. On the plus side, my PSA was undetectable (< 0.02 ng/mL) 8 weeks after surgery, and an upcoming testosterone total/free test (TGRP) should say something similar. If the T rises I'm going to advocate for a different ADT (Orgovyx likely). And before that I will also request a DEXA, baseline bone scan. My oncologist is going to hear all of this, as soon as his office calls and schedules me. I'm diverging from the surgeon's expertise at this point.

I think you're on the right path and in competent hands. My biggest concern was to obtain a surgeon with significant (thousands) experience in the urologic/robotic field. Reattaching the tubing, 2nd only to getting all of the cancer/prostate, seems to me to be an important aspect of this ordeal.

@krs03 thank you. Very helpful Congratulations on the successful surgery. I hope I’m as lucky as you Let’s continue the conversation.

@krs03 may I ask where you got your surgery??

Seattle, WA. Providence/Swedish hospital.
Keep your spirits up, it all helps.
And please update us all, I've learned a lot in this group.

Great thanks. Will do 💪

Are you having radiation in addition ADT? Even with undetectable PSA you still need radiation to scramble the DNA of the remaining cancer cells and hopefully destroy them.
The nodal dissection indicates escape of cells and they are not always captured by the lymphatic system.
I’m sure you know this already - just saying it for the benefit of those uninitiated observers on the forum who may conclude that ADT alone “kills” PCa.
Best of luck,
Phil

@heavyphil So I haven’t started any treatments yet. Yes, I understand that ADT slows and shrinks but doesn’t kill Pca. Current plan from CC is to do several months of ADT and then surgery. I’m waiting to hear recommendation from Mayo Jax . The RO I met with at Mayo thinks surgery best option. I’m hoping to hear from the surgeon there this week. Thanks for clarifying. 🙏