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

PSA definitely 0.6 for the past five years. No symptoms other than some frequency in the night. Digital/rectal every year by my GP found nothing but the urologist felt the 5mm nodule immediately. Then showed up on the echography and then the MRI followed by bone scan ( clear and recently the CT scan - also clear ). PET scans on offer 50 km away but had not heard of FDG so thanks for that.

As you say, lots to think about.

Best regards,

David

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.

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 .

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.

Everyone is different. There is no set answer we can give you as to whether or not that will be all you ever need for treatment. It is becoming more common to have a few SBRT sessions along with IMRT. The SBRT sessions concentrate on the prostate while IMRT Sessions Focus on the prostate bed.

My brother with a 4+3 had only five sessions of SBRT. No need to do the whole prostate bed since his cancer had not spread. He was 76 when this was done.

I am really puzzled by your comments about your PSA. You say it’s always been .6, Are you sure about that? If it’s that low, then you may need an FDG scan because you may not be producing PSMA either.

A CT scan cannot find all of the cancer in somebody’s body. A PSMA pet scan is a much better choice since it can actually see metastasis, which a CT scan cannot see. Can you get a PSMA pet scan Before doing radiation. That may not be enough, however, if you don’t produce PSMA either than you need an FDG scan.

Some more things to think about.

Recently received IMRT 28 sessions and started Orgovyx one month before start of radiation therapy. I was Gleason 8(4+4) with PSA at 17, after many years at 3.5-5.5! PET scan showed no signs of spread outside of the prostate(yay!).
1 month from IMRT finish, PSA was < .5 and testosterone was 3.
I’m optimistic that on next urology visit, my PSA will remain low or get even to undetectable as my urologist said IMRT doesn’t kill all cancer cells immediately and continues “killing” for 1-2 months post treatment.
At that juncture should PSA get even lower, I am considering stopping Orgovyx at 6-8 months total.
Thoughts from the group????
Pat

That is a really interesting chart, Jeff. I realize that it is produced by a group that obviously promotes Cyberknife, but I thought the marginal accuracy of proton beam was on a par with SBRT?

Does anyone know just how effective IRMT ( RT ) for 35 days is against a case like mine ( Gleason 7 ( 4+3 ) without ADT actually is?

That is really helpful, thank you. A friend in the UK ( I am in France ) had HIFU recently and seems happy so far, not sure if it is available here yet. PSMA - Pet scans only available so far in major centres like Paris, Toulouse, Bordeaux. However am looking at SRBT as an option.

Many thanks,

David

My teacher simply says 'Time on the instrument' !

Impressed with your range of activities.

David