1. < Prostate Cancer

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

Posted by zooblio6 @zooblio6, Dec 26, 2024

Hello,

I will be 80 next August and apart from newly diagnosed PC am in good overall health. I have a diagnosis of Gleason 7 (4+3) Grade 3, T2a with a five year PSA of 0.6. Six cores positive in the recent biopsy. No spread to the bones or organs as indicated by CT scans etc. I see my urologist on 7th January and am concerned that he will propose ADT in addition to the inevitable RT ( I suspect IRMT ).

The side effects concern me ( although I already have erectile dysfunction ) mostly those concern possible memory loss, bone and muscle loss and cardiovascular risk ( I have controlled high blood pressure ).

I have read several recent reports that indicate that ADT may represent overtreatment in older patients and the more so where the cancer grows more slowly. Quality of life is key for me and my wife.

Can anyone please give a measured/qualified overview please. Thank you.

David

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

zooblio6 | @zooblio6 | 3 days ago
In reply to @zooblio6 "Completely respect your view. However, age and co-morbity is a factor here. I shall be 80..." + (show)
@zooblio6

Completely respect your view. However, age and co-morbity is a factor here. I shall be 80 in August and that for me is key. Recent research has shown that side effects ( let alone double side effects from combined treatment ) added to comorbidity issues and existing conditions have an added effect at this age. For instance, key side effects of ADT including bone and muscle loss (fractures/falls), memory loss/cognitive issues, cardio-vascular problems ( I have controlled high blood pressure) all exacerbate likely pre-existing age-related problems. Advances in modern radiation accuracy and dose escalation have narrowed the margin of improvement conferred by ADT and at this age raise questions of balance relating to quality of life. Recent research bears this out. I am prevented from posting links as a new subscriber but do have a search for:-
'Risk of Death in Octogenarians with Intermediate Risk Prostate Cancer Who are Treated with Radiation Therapy (RT) Plus Androgen Therapy (ADT) Versus Radiation Alone, and NCBD Analysis ( Vol.20 - Issue 2, Supplementr E526-527, October 01, 2024.

'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' - Journal of Clinical Oncology

April 27, 2020

Regards,

David

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I feel sure that most forum members will be aware of the PCRI in Los Angeles. Run by Dr Mark Scholz and team it is a mine of information. Their You Tube page 'Alex Scholz' has masses of highly relevant videos and this one is no exception and seems to relate well to this discussion............

'Intermediate-Risk: Do You Need Hormone Therapy With Radiation?"

David

REPLY
ava11 | @ava11 | 2 days ago
In reply to @jeffmarc "50 years in computers, 25 working for others doing programming in over 10 languages mostly on..." + (show)
@jeffmarc

50 years in computers, 25 working for others doing programming in over 10 languages mostly on IBM main frames, wrote a lot of machine language code. Then I started my own consulting business and had around 100 clients, 26 architect offices. Always a challenge installing new servers and resolving network and software/hardware issues.

Prostate Cancer is just another challenge, just wish I had more control over it.

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Jeffmac,
I started computer programming as a student at University of Michigan in 1961. Later, I wrote operating systems software and compilers for Burrows machines. Finally retired as a Data center manager at County of Los Angeles in 2005.
Dr. Schulz suggested that I should take a holiday now from Orgovyx. But, my computer mind tells me that I should continue until my PSA reaches a plateau or at least 12 months whichever comes first. just finished 9 months.
My reasoning is if PSA dropping means treatment is working, so why stop the medicine. My quality of life with hormone therapy is not great but certainly acceptable that I can live with it rest of my life if I have to!
My PSA on October 7th was 0.05. I am hoping it will keep dropping some more in the next 3 months.

REPLY
jeffmarc | @jeffmarc | 2 days ago

I understand your desire to continue taking the drug because your PSA continues to drop. Your PSA however, is very low, And that is why Doctor Scholz Said you could stop Orgovyx. Taking the drug for another three months is no big deal, your testosterone will probably come back just as quickly with that small addition of time.

A lot of people don’t get the ultra sensitive PSA test so for them being < .1 For nine months would be enough for some people to say drop the drug And see what happens.

I’m sure you’ve Read other comments about this, discussing the fact that you should get PSA tests no less than every three months when you do drop ADT. Wish you the best with your treatment decision, Hopefully it will give you years without recurrence.

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1 reply
ava11 | @ava11 | 1 day ago
In reply to @jeffmarc "I understand your desire to continue taking the drug because your PSA continues to drop. Your..." + (show)
@jeffmarc

I understand your desire to continue taking the drug because your PSA continues to drop. Your PSA however, is very low, And that is why Doctor Scholz Said you could stop Orgovyx. Taking the drug for another three months is no big deal, your testosterone will probably come back just as quickly with that small addition of time.

A lot of people don’t get the ultra sensitive PSA test so for them being < .1 For nine months would be enough for some people to say drop the drug And see what happens.

I’m sure you’ve Read other comments about this, discussing the fact that you should get PSA tests no less than every three months when you do drop ADT. Wish you the best with your treatment decision, Hopefully it will give you years without recurrence.

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Thank you Jeffmarc for your comments. Dr Amar Kishan when he treated me with SBRT in April, he suggested ADT for 1 year. I asked him what if I don't take ADT. He said my cancer coming back is 50%. ADT cuts it down by 50%. That means there is 25% chance that cancer coming back!
When I told him that Dr Schulz said that I can stop ADT now, he said it is ok!
It is all probabilistic, nothing definitive for sure!

REPLY
1 reply
zooblio6 | @zooblio6 | 1 day ago
In reply to @ava11 "Thank you Jeffmarc for your comments. Dr Amar Kishan when he treated me with SBRT in..." + (show)
@ava11

Thank you Jeffmarc for your comments. Dr Amar Kishan when he treated me with SBRT in April, he suggested ADT for 1 year. I asked him what if I don't take ADT. He said my cancer coming back is 50%. ADT cuts it down by 50%. That means there is 25% chance that cancer coming back!
When I told him that Dr Schulz said that I can stop ADT now, he said it is ok!
It is all probabilistic, nothing definitive for sure!

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Might be an idea to get your guy to read the two recent reports I cited earlier in this thread clearly questioning the marginal difference made by ADT over modern radiation. Maybe he already knows them. My guy did not.

As you suggest, its something of a lottery.

David

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