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

Good luck with that and thank you.

Do a search for this report from 2022: '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'. Note especially the Conclusion.

David

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.

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.

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

Yup, the fiber thing drove me crazy. They are paranoid about gas in the rectum and gut during radiation and I certainly understand why, but I am Joe Fiber and that freakin diet of Rice Krispies, mashed potatoes and boiled green beans really made me want to puke.
I started to gain some weight so I just ate more protein and used non fermentable fiber supplements to stay regular….wasn’t easy! Also exercised every single day - some weights, indoor cycling and walking.
Actually going to Sloan today to pick up my last (6 month regimen) bottle of Orgovyx. Although I am glad it will be done in a month I would be lying if I said that I was not a little apprehensive about going off of it. This stuff really works!

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🤞

Jeff,
What age is your brother now ? What were his side effects ?
Thanks .
p.s. I am considering Monotherapy SBRT . I am coming 85 years young.

My prayer everyday is to get off of Orgovyx plus Abberaterone (plus Prednisone) to regain testosterone and quality of life.
I’m 68 with Gleason 8, stage 3 advanced,and baseline PSA of 7.0
I’m 9 months into ADT and 43 radiation treatments this past summer.
I’ve taken to heart from the start of ADT the crucially important need for daily resistance training and it has made a major difference for me.
Last PSA score in Nov was 0.03 so I’m hoping to string together maybe 3 more of those or better scores (9 months) and get off ADT earlier than the prescribed 24 months.
Thanks in advance for any thoughts/comments

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.

He is 79

Side effects were hot flashes from being on ADT for six months, It lasted for a year after ADT was stopped. Use Orgovyx for the ADT drug and your testosterone will recover quickly. Ask your doctor if he thinks it’s appropriate for you.

He had problems peeing so he went on Flomax and that resolved it. He had that problem for about a year, on and off.

Your monotherapy option sounds just right, But I am not a doctor. I have not reviewed your medical scans and documentation so I don’t know exactly what’s going on. If it’s truly isolated to the prostate, then SBRT works great for most people. At your age you have many more years before prostate cancer becomes an issue, there are so many treatments.