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

No regrets Heavyphil and I'd most likely do the same thing again given the available information. The diagnosis that I received had more disclaimers than Autopilot on a Tesla, e.g. T1c/T3a why not pick one or the other. Even the designation 'unfavorable' leaves a lot to be desired, just saying G8 would be more objective grading. By not being more clear, the onus is on patients to do more research and make decisions.

My biggest concern is over treatment since I lost a much loved body part that was removed unnecessarily. Now, I practice a great deal more due diligence on any recommendations from the medical community.

It is also clear to me that medical units are siloed and typically focus on their, and only their issues. I've been pre-diabetic for 20+ years and gaining extra weight puts me at risk for heart attack and stroke. When I queried the blood work orders placed by my RO regarding lipids, the reply was something on the order of, "it's not my job man". The team was also suggesting a variety of other diet remedies, like avoiding fiber, that would surely drive up my A1c and cholesterol.

Best wishes and hopes that you stay forever in remission.

I have similar concerns. In the following medical journal article (https://pmc.ncbi.nlm.nih.gov/articles/PMC10949134/), the University of Michigan authors write, "Although improvements in biochemical failure might be important, we must not forget that non-prostate cancer deaths remain the dominant mode of death, and treatments can worsen other-cause mortality. For example, the addition of hormone therapy to salvage radiotherapy in patients with PSA less than 1.5 increased other-cause mortality and cardiac events. Thus, the poor correlation of biochemical failure-free survival with overall survival might also be due to treatment intensification resulting in worsened other-cause mortality without greater improvements in prostate cancer-specific mortality." Of course, every case is different. But the point the authors were making is that treatments like ADT take a toll of their own. I recommend reading that medical journal article in its entirety. You'll find it at the link that I provided.

Seasuite, Don’t regret having ADT. I was also Gleason 4+3 unfavorable. Had surgery but then had a recurrence 5 yrs later and needed radiation and ADT.
Hopefully, your treatment -because of the ADT - will be a one and done.
I think when the word ‘unfavorable’ is in the mix ADT is a good idea….JMHO.

Thanks for the reply! I’ll be getting PSA checked every 3 months for sure. My radiology oncologist recommended 18 months on hormone therapy but recent studies my wife found suggest little benefit after 6-8 months. I’m weighing quality of life, too, as I’m 78 years old in excellent health……other than PC!

David,
I'm arriving a bit late to this thread and may have missed what's already covered. I found my diagnosis to be hopelessly vague, despite half a dozen second opinions.. 71 Year old man with NCCN unfavorable intermediate risk prostate adenocarcinoma -- T1c (T3a based on MRI) M0N0 ISUP Group Grade 3 (Gleason score 4+3; 4/14 systematic cores); initial PSA of 4.08 ng/mL; Decipher 0.57 intermediate.

After a great deal of discussion and research, I completed tri-modal: Orgovyx/4 months; 2x Cyberknife boost; 23x IMRT and now, thankfully, am in "remission".

When I first questioned the diagnosis and ADT in particular, I was told that I had 'risk factors' that 'may make me high risk'...OR not. That led me to complete a PET SCAN and Decipher Grid, which you may have done already, but, are great since they are easy and non-invasive.

I completed treatments in Jan. of this year and, again thankfully, have very few side effects. However, my T has not returned to normal, it's about 50% of previous, and that has associated: belly fat, slightly less strength, moderate ED. Given the information that was available to me, I'd make the same choice, but, would have certainly preferred to have enough valid data to avoid ADT.

For Gleason eight they recommend 18 months of ADT. You can stop sooner, ask your doctor what they think, but most people don’t do this unless they are undetectable for At least a few months.

If you do stop, get PSA test no less than every three months, At least for a while to make sure your cancer is not coming back.

78 y old , G =3+3, only 1 out 6 was cancer positive and less than 5% total sampled cells,
ADT for 2 month DEEPLY suppressed the imm-system - - - in one month got twice cold with very serious symptoms - - - before so health never got more than twice in a whole year for decades, not even mention all the time (years) COV-19 tested negative the same time all the 5 family members positive.

After 28 runs of IMRT, firmly denied further ADT.

David , MY PLEASURE . I am a Patient Advocate for Prostate Cancer here in Canada ( near Toronto )
Two of my fellow club members - ( The Club Nobody Wants To Belong To - Cancer Club ) who I advised underwent their procedures in Germany at the Prostate Center in Offenbach ( Vitus Privatklinik ) .
One selected NanoKnife , where this clinic has performed thousands of this procedure . The other Immunotherapy -- both gentlemen , one of which is formerly from Austria and now resides in Canada , are in their seventies . They are both pleased with their individual selections and the results .
For the NanoKnife gentleman : Google " NanoKnife Niagara Now ." He is an author and contributor to a local newspaper in the Niagara Falls Area . He wrote three articles addressing his trip to and procedure in Germany .
At the time he was unaware that several centers in Toronto and others across Canada performed the NanoKnife procedure . In recent months two more of my club members have had the NanoKnife in Toronto - Both also a success and both also in their early seventies .
GOOD LUCK .