First MO visit - review NCCN w MO as part of the treatment discussion?

I guess I went the opposite way. I had the discussions with the docs, took detailed notes, and then checked them against guidelines. If any were off, I would have discussed. None were.

A big question is, are you seeing a Genito urinary oncologist or are you just seeing a medical oncologist? The GU oncologists specialize in prostate cancer and Usually do the best job with treatment decisions.

The NCCCN guide guidelines can be difficult to interpret, You don’t give any information about your case so it’s really hard to say anything about what the NCCN would say about you.

Many of us have an idea, based on the diagnosis. what the requirements recommend.

@jeffmarc Jeff, let me clarify - I'm seeing a Genitourinary Oncology for the first visit. The visit is at Fred Hutch in Seattle.

What I did was to map the biopsy and PSMA Pet results using AI to the NCCN guidelines and am going to try this approach to present my findings and use this as the basis for a discussion once he discusses possible treatment. If what I learned is not accurate then I'm fine w this - I'd rather present a POV on my use case, gauge feedback and then identify the path forward.

I'm a Gleason 9 (4+5) with cancer that has found its way into a few lymph nodes. Hence surgery is likely ruled out for now and likely combo treatment of Orgovix with Nubeqa is what the analysis is reporting back.

I welcome input from the group to help me consider other potential treatments I can discuss when I meet at Hutch on Tue...

Thx

@mjp0512 Makes sense. Ty for the feedback...

Cheers

I waited until my MO made his recommendations, which was Lupron for 18 months. I told him I would prefer Orgovyx, judging by everything I had read about side effects from both. He didn't hesitate to go along with me. I'm Gleason 8 with crib and IDC, but confined to the capsule, so no Nubeqa needed thankfully. Make certain your RX plan covers both before you ask for them, because they are both rather expensive. If you are going to a Genitourinary Oncologist at Fred Hutch, I am pretty certain he/she knows NCCN guidelines for your particular case. I would listen to his treatment plan first, it may well be identical to your AI generated plan. We need to be our own advocates, but also need to have full trust in our Doctors throughout this whole complicated process.

@gonzaler84
You got it Orgovyx (ADT) Plus an ARPI (Nubeqa) Followed by radiation to the prostate and the lymph nodes that are a problem. That’s the standard of care.

You could have IMRT or SBRT. If you have SBRT, it would be five sessions for the prostate and maybe a couple more (or more) To the lymph nodes. Sometimes they want to do IMRT for the whole thing, but either one would work And that could take more than 30 sessions.

Focal therapy is definitely not in the picture.

@jeffmarc Ty for the feedback and addl guidance on treatment considerations...

Cheers

@gonzaler84 what Jeff stated is by far the most recommened treatment protocol for what you have. Radiation plus ADT ( Orgovyx/Nubeqa). Only real question is radiation - no of sessions which your radiation oncologist will recommend and the other question is length of ADT..You are looking at min 18 mos I would guess.
The real question is how well you respond. Hopefully your PSA will drop dramatically within first 3-6 months to close to undetectable level. That is the goal.

Be prepared for some side effects which you can discuss on this board. Dont worry, everyone here has been a rookie- discuss questions problems as they arise. Good luck !