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

I'm 60 and had pretty much the same diagnosis as you. I did SBRT (accelerated RT) and six months of ADT. I started with Lupron but had very bad mental side effects (depression, suicidal thoughts, forgetting names of people I'd known for years) so I switched to Orgovyx after two monthly Lupron injections and it was a lot better. It also has worn off much faster. I'm two months out from it now and feel no more effects from it while people in my support group who are on Lupron say it takes 3-6 months to return to normal after stopping.

If you are going to do ADT, I would suggest either Orgovyx (daily pill) or a MONTHLY injectable vs. the 3 or 6 month injectables because that way, if the side effects are too much for you, you can stop or switch to something else.

Note that only a couple other guys in my group got the same side effects as me. Others got physical side effects like hot flashes which I didn't get. So it seems everyone's side effects vary somewhat.

David, I had similar diagnosis as yours (4+3) three years ago at age 74. Urologist and radiologist both were insistent on ADT. I also had no spread and cancer was limited to prostate.
I decided to have proton therapy only due to all the potential effects of ADT. My logic was largely based on protecting my current quality of life at my " young age" with the understanding that there could be some additional risk of a recurrence in later life. A roll of the dice , no doubt, but three years later all looks good so far.
Not endorsing my decision for anyone else but only for me. Best, Ron

Thanks Ron, that is exactly where I am at ( or suspect I will be when I see my guy on 7th January ). After tons of research, I was beginning to feel a bit lonely out there in terms of not going with the flow. Great reinforcement.

Best regards,

David

Happy to discuss my story in more detail if it would help you. Best, Ron

That would be great and thanks again. Just to clarify, I am Grade 3, Gleason 7
( 4+3 ) T2a, but with a consistent 5 year PSA of 0.6 and no symptoms. A key factor is that there is a genetic link to my late brother who died of PC. Localized to one half of the prostate hence the T2a rating and nothing in the bones or organs.

Any perspective / input would be more than helpful ( I trust that you are on an even keel now btw ). Meeting on the 7th here in France with the HOD of urology at our regional hospital no doubt to discuss treatment options. His proposal will be based on findings of a panel comprising urologist, oncologist and radiologist. He however seems very keen on ADT.

Look forward to your story.

Best regards,

David

David, my PSA had been increasing for several years and my PCP sent me to a urologist. It turns out that because I had been taking medication to help reduce the number of night "pee" trips, my actual PSA was double (9) the number that was indicated by yearly lab tests.
A biopsy was quickly performed which when reviewed by a pathologist indicated 6 out of 12 cores contained cancer , four of which were 4+3 with the remaining two 3 + 3.
Consulted with a urologist and radiologist both of which indicated ADT was required. In the meantime, I had an MRI to look for any spread and had a 2nd pathologist from John's Hopkins perform a review of the cores which confirmed the findings of the first pathologist,
I had to wait several weeks to have a PSMA pet scan to look for spread and it confirmed there was none outside of the prostate. Your research has probably made you aware that a PSMA pet scan is significantly more effective than an MRI in finding cancer outside the prostate .

(continued) I had a Decipher test performed which evaluates the aggressiveness of your particular cancer and mine was slightly below the mid range.
Decided I was leaning toward Proton Therapy and consulted with Proton Therapy radiologist who also strongly recommended ADT.
Consulted with widely known 2nd Proton Therapy radiologist who indicated that he believed expected lifespan gain from ADT was largely, but certainly not completely, offset by negative health effects it can bring.

(continued) This information gave me confidence to go in the direction I was already leaning toward which was no ADT.
Had six weeks of Proton radiation in May and June of 2022 and PSA has continued to decline to below 1 as of the most recent two quarterly PSA tests. Only minor residual side effects from radiation which are weak stream and an occasional dribble. Hope this helps! Best , Ron

(continued) This information gave me confidence to go in the direction I was already leaning toward which was no ADT.
Had six weeks of Proton radiation in May and June of 2022 and PSA has continued to decline to below 1 as of the most recent two quarterly PSA tests. Only minor residual side effects from radiation which are weak stream and an occasional dribble. Hope this helps! Best , Ron

Thanks again, I am coming to that view. Not sure my urologist will agree, but at this age, quality of life is important. For instance, as a musician I would find memory issues a bummer. Thanks again.

David