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

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.

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.

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 .

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.

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

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.

Really helpful - many thanks.

David

Also, 28x IMRT was none of any even small side effects , as well the following 6 months until the two weeks of hemorrhoid like pain came. The symptoms finally gone completely by using 4% Lidocaine Ointment rectally.
Everything now normally.

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!

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.