Being treated for Gleason 9

I know people with Gleason nine but are still around for 30+ years.

As long as your PSA is undetectable for almost 18 months Stopping Orgovyx can work for you. Just get regular PSA tests.

There was nothing else in your biopsy besides Gleason nine right? Things like cribriform, intraductal, seminal vesicle invasion can cause problems,

Thank you. I don't think I have any other complicated?

Your ADT + radiation is standard treatment for a Gleason 9 (as the attached NCCN guidelines show).

However, those NCCN guidelines also show an alternative treatment of “doublet therapy” consisting of ADT + ARPI + radiation, which has been shown to result in better outcomes. A number of clinical trials have shown better outcomes with doublet therapy as well (see attached chart).

As for what to expect —> First, I would expect success. I would also ask my doctor why doublet therapy wasn’t used in order to increase the chance of success.

I think that your prognosis is good.
I had surgery at age 72 and Salvage Treatment immediately after due to persistent PSA post op. Gleason 9 with EPE. My PSA has been undetectable for over 18 mos (began testing 6 mos following radiation; which also was 5 mos after completing ADT Orgovyx).
I have hope that my PCa has been eradicated.
That said, I anticipate recurrence at some time in the future; and if it were today, would expect the doublet tx described and hope for a better option in the future.
Best wishes for health and a peaceful mind.

Thanks to all for the advice. Greatly appreciated.

Honestly, they don't know your chance, because all data on survival is retrospective (SEER, etc), and prostate cancer treatment has changed so dramatically in the past 5–10 years that none of the older data is all that applicable any more.

I'm stage 4 oligometastatic. They told me initially at diagnosis in 2021 that typically I could expect to live 3–5 years, but maybe 7 at a stretch in my case because I was otherwise young and healthy. The also said that my cancer would become castrate-resistant in 12–18 months and I'd likely move on to chemo, Pluvicto, or similar.

Now it's 2025, and none of that has happened: I'm still on ADT+Apalutamide, but in deep functional remission and NED (no evidence of disease), and they don't talk about the best-before dates for me any more. 🙂 While they told me the old, out-of-date prognosis back in 2021, they still gave me the newest treatments, and those seem to have made a huge difference.

Hi...I'm being treated for G9 too. Unfortunately, my PSMA PET lit up like a Christmas tree. So be it. Currently on doublet therapy (Orgovyx & Nubeqa) with radiation coming up in a couple months. Hang in there. We got this.

(Hey look at that. I finally got autocorrect to stop putting a "U" after the "Q" in Nubeqa)

I'm really sorry to hear that. I assume that "lit up like a Christmas tree" would mean widespread metastases (polymetastatic)? If so, will the radiation be via Pluvicto?

Thank you. Abdomen and chest cavity lymph involvement along with bone metastases in vertebrae. Pluvicto is not part of the current treatment plan. That's not to say it won't come down the road. The hope right now is that the ADT/ARI combo will shrink the main tumor in the prostate a little before radiation. I hope so. I would really like to pee on my own without having to stick a catheter in there 5 or 6 times a day. I'm slightly ambivalent about the whole thing. I'm a CHF patient as well and have been for years. I fully expected to bite the dust from heart failure years ago. This is kind of bonus time for me and regardless, today's a pretty good day.

Keep your sense of humor and thanks