Gleason 7 (4+3) radiation, but ADT also? Over treatment?

Posted by zooblio6 @zooblio6, Dec 26, 2024

Hello,

I will be 80 next August and apart from newly diagnosed PC am in good overall health. I have a diagnosis of Gleason 7 (4+3) Grade 3, T2a with a five year PSA of 0.6. Six cores positive in the recent biopsy. No spread to the bones or organs as indicated by CT scans etc. I see my urologist on 7th January and am concerned that he will propose ADT in addition to the inevitable RT ( I suspect IRMT ).

The side effects concern me ( although I already have erectile dysfunction ) mostly those concern possible memory loss, bone and muscle loss and cardiovascular risk ( I have controlled high blood pressure ).

I have read several recent reports that indicate that ADT may represent overtreatment in older patients and the more so where the cancer grows more slowly. Quality of life is key for me and my wife.

Can anyone please give a measured/qualified overview please. Thank you.

David

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

I understand your desire to continue taking the drug because your PSA continues to drop. Your PSA however, is very low, And that is why Doctor Scholz Said you could stop Orgovyx. Taking the drug for another three months is no big deal, your testosterone will probably come back just as quickly with that small addition of time.

A lot of people don’t get the ultra sensitive PSA test so for them being < .1 For nine months would be enough for some people to say drop the drug And see what happens.

I’m sure you’ve Read other comments about this, discussing the fact that you should get PSA tests no less than every three months when you do drop ADT. Wish you the best with your treatment decision, Hopefully it will give you years without recurrence.

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@jeffmarc

50 years in computers, 25 working for others doing programming in over 10 languages mostly on IBM main frames, wrote a lot of machine language code. Then I started my own consulting business and had around 100 clients, 26 architect offices. Always a challenge installing new servers and resolving network and software/hardware issues.

Prostate Cancer is just another challenge, just wish I had more control over it.

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Jeffmac,
I started computer programming as a student at University of Michigan in 1961. Later, I wrote operating systems software and compilers for Burrows machines. Finally retired as a Data center manager at County of Los Angeles in 2005.
Dr. Schulz suggested that I should take a holiday now from Orgovyx. But, my computer mind tells me that I should continue until my PSA reaches a plateau or at least 12 months whichever comes first. just finished 9 months.
My reasoning is if PSA dropping means treatment is working, so why stop the medicine. My quality of life with hormone therapy is not great but certainly acceptable that I can live with it rest of my life if I have to!
My PSA on October 7th was 0.05. I am hoping it will keep dropping some more in the next 3 months.

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@zooblio6

Completely respect your view. However, age and co-morbity is a factor here. I shall be 80 in August and that for me is key. Recent research has shown that side effects ( let alone double side effects from combined treatment ) added to comorbidity issues and existing conditions have an added effect at this age. For instance, key side effects of ADT including bone and muscle loss (fractures/falls), memory loss/cognitive issues, cardio-vascular problems ( I have controlled high blood pressure) all exacerbate likely pre-existing age-related problems. Advances in modern radiation accuracy and dose escalation have narrowed the margin of improvement conferred by ADT and at this age raise questions of balance relating to quality of life. Recent research bears this out. I am prevented from posting links as a new subscriber but do have a search for:-
'Risk of Death in Octogenarians with Intermediate Risk Prostate Cancer Who are Treated with Radiation Therapy (RT) Plus Androgen Therapy (ADT) Versus Radiation Alone, and NCBD Analysis ( Vol.20 - Issue 2, Supplementr E526-527, October 01, 2024.

'Dose-Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Deprivation for Intermediate-Risk Prostate Cancer:

Results of a Phase 111 Multi-Institutional Trial' - Journal of Clinical Oncology

April 27, 2020

Regards,

David

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I feel sure that most forum members will be aware of the PCRI in Los Angeles. Run by Dr Mark Scholz and team it is a mine of information. Their You Tube page 'Alex Scholz' has masses of highly relevant videos and this one is no exception and seems to relate well to this discussion............

'Intermediate-Risk: Do You Need Hormone Therapy With Radiation?"

David

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@itsaquarter23

I would have done the same thing that you did, heavyphil. Six months of ADT is a small price to pay for the extra assurance. Now, if the doctor had said 18 months, I would have said, no. I think the longest I'd want to be on ADT—even if I had aggressive pc—is nine to 12 months to preserve long-term quality of life.

Jump to this post

Completely respect your view. However, age and co-morbity is a factor here. I shall be 80 in August and that for me is key. Recent research has shown that side effects ( let alone double side effects from combined treatment ) added to comorbidity issues and existing conditions have an added effect at this age. For instance, key side effects of ADT including bone and muscle loss (fractures/falls), memory loss/cognitive issues, cardio-vascular problems ( I have controlled high blood pressure) all exacerbate likely pre-existing age-related problems. Advances in modern radiation accuracy and dose escalation have narrowed the margin of improvement conferred by ADT and at this age raise questions of balance relating to quality of life. Recent research bears this out. I am prevented from posting links as a new subscriber but do have a search for:-
'Risk of Death in Octogenarians with Intermediate Risk Prostate Cancer Who are Treated with Radiation Therapy (RT) Plus Androgen Therapy (ADT) Versus Radiation Alone, and NCBD Analysis ( Vol.20 - Issue 2, Supplementr E526-527, October 01, 2024.

'Dose-Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Deprivation for Intermediate-Risk Prostate Cancer:

Results of a Phase 111 Multi-Institutional Trial' - Journal of Clinical Oncology

April 27, 2020

Regards,

David

REPLY
@heavyphil

I actually read this article when I first knew I would need salvage radiation. I consulted with an RO who totally agreed with the article, telling me that any PSA less than .7 did not need ADT, only radiation.
I then consulted with Sloan and they said I DID need ADT, which had been my feeling, in spite of the newer findings. I asked my urologist what he thought and he said that although the newer findings supported the idea of no ADT, 6 months on Orgovyx in an otherwise healthy or medically supervised patient “couldn’t hurt”.
My feeling was that my Gleason 4+3 unfavorable just might be a bit more aggressive than “Intermediate” might imply and even though my surgical pathology was negative, it STILL recurred. So I wanted to hit it as hard as I could so hopefully I could end this problem once and for all🤞

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I would have done the same thing that you did, heavyphil. Six months of ADT is a small price to pay for the extra assurance. Now, if the doctor had said 18 months, I would have said, no. I think the longest I'd want to be on ADT—even if I had aggressive pc—is nine to 12 months to preserve long-term quality of life.

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@zooblio6

Just finished ( reading ) - highly relevant and thank you. For instance, my main 'risque associée' would be hypertension ( Fr ) or raised ( but controlled ) blood pressure. I would not want issues with that. At the same time, as an amateur jazz musician, I have always benefitted from a semi-photographic memory and would not want to give that away in return for seemingly minimal yet unquantified benefits. If I di accept 90 days of HT I am wondering if side effects are pro-rata reduced?

David

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I'm no doctor, but I've listened to experts discuss this topic. The general consensus was that four to six months of ADT is generally very tolerable for most people, and those patients typically return to normal afterward without any significant long-term effects. A patient who'd been on ADT for two years told me that patients can generally return back to normal if they undergo ADT for a year or less. But if patients are on ADT for 18 months or more, the ADT-related harm can be very long-term. So the length of time matters. 90 days isn't long at all. I haven't heard of anybody being prescribed ADT for that short time frame. Usually, the minimum amount of time for ADT in the U.S. is four months. Bonne chance!

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@heavyphil

Well, if it’s ONLY 15 years then it’s really nothing special…😂….haha!
Your attitude has a lot to do with how you come to grips with any illness in my opinion; but even
more, the actual ‘way’ your mind works can’t be underestimated.
I think you mentioned in one post that you did work with computers - and probably software and programming and troubleshooting? Well it takes a very analytical mindset to do that and even though all of us have this quality to some extent, computer people have that Yes/No ‘flow chart’ mentality that they taught us in Computers 101 in high school: If not A, then B….and if B, then C or D….
I think this logical next step reasoning is very important and it frees you from becoming so emotionally worked up that panic, helplessness snd despair soon take over and you start to drown.
Having prostate cancer can be a real rollercoaster both physically and emotionally so it always helps to have someone with a cool head help you get through it.
Phil

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50 years in computers, 25 working for others doing programming in over 10 languages mostly on IBM main frames, wrote a lot of machine language code. Then I started my own consulting business and had around 100 clients, 26 architect offices. Always a challenge installing new servers and resolving network and software/hardware issues.

Prostate Cancer is just another challenge, just wish I had more control over it.

REPLY
@jeffmarc

It really is 15 years not 17. I never had metastasis in the first eight years, So I don’t think chemo would’ve been in the picture even if they knew I had BRCA2. Only one Metastasis on the spine (L4) so far. Waiting for the pin to drop!!!

People are SO different in how their bodies react to PC. I don’t know if it helps but mentally I have not really been concerned about my PC getting worse. I don’t really think about it, Even when waiting for the results of my monthly PSA tests. Does mental attitude make a difference??? Nahhhhh!!

Jump to this post

Well, if it’s ONLY 15 years then it’s really nothing special…😂….haha!
Your attitude has a lot to do with how you come to grips with any illness in my opinion; but even
more, the actual ‘way’ your mind works can’t be underestimated.
I think you mentioned in one post that you did work with computers - and probably software and programming and troubleshooting? Well it takes a very analytical mindset to do that and even though all of us have this quality to some extent, computer people have that Yes/No ‘flow chart’ mentality that they taught us in Computers 101 in high school: If not A, then B….and if B, then C or D….
I think this logical next step reasoning is very important and it frees you from becoming so emotionally worked up that panic, helplessness snd despair soon take over and you start to drown.
Having prostate cancer can be a real rollercoaster both physically and emotionally so it always helps to have someone with a cool head help you get through it.
Phil

REPLY
@heavyphil

So perhaps the addition of ADT earlier might have made a difference? But I think you’ve pointed out that the BRCA2 problem might have even eclipsed ADT and caused the cancer to come back anyway.
I guess today you would have gotten the triplet therapy regimen - that’s ADT combo plus chemo?
Still amazing to me that you have beaten this thing back for 17 years and are still standing strong….Happy New Year, Jeff, and thank you once again for all your help, knowledge and support!
Phil

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It really is 15 years not 17. I never had metastasis in the first eight years, So I don’t think chemo would’ve been in the picture even if they knew I had BRCA2. Only one Metastasis on the spine (L4) so far. Waiting for the pin to drop!!!

People are SO different in how their bodies react to PC. I don’t know if it helps but mentally I have not really been concerned about my PC getting worse. I don’t really think about it, Even when waiting for the results of my monthly PSA tests. Does mental attitude make a difference??? Nahhhhh!!

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@jeffmarc

Your timing for getting off ADT sounds just right. Just make sure to get those PSA tests no less than every three months.

I went from 4 abiraterone pills to 3 to try and improved brain fog issues. In 18 days, my PSA went from .2 to 1. I went right back on four pills. Just something to think about, Mine was never below .09 and you are able to get to .03, yours is essentially undetectable.

You don’t mention a decipher score. Is there any chance you could get one, That can tell you how aggressive your cancer is, more info than the Gleason score.

Have a great New Year.

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Thanks for your comments and I will ask about the decipher score which has not been mentioned to me by my care team.
Happy New Year to you as well!

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