Was Gleason 7 (3+4): How soon can one get off ADT (Orgovyx or Lupron)?

with a Gleason seven the NCCN recommends six months for ADT. Now that’s a guideline not a hard rule. When you had your biopsy was there cribriform or intraductal mentioned, That makes your cancer more aggressive, and SBRT radiation is not sufficient and 6 months would be low. There are a couple of other things that would mean that your Gleason seven could be more aggressive than other people’s seven. if there was nothing found in your biopsy, that was questionable, then as long as you are undetectable for five or six months it. could be enough.

Did you have a Decipher test done? That could give you an idea of the chance recurrence soon.

Hi Jeff,
I figure you have listened to/joined many webinars, and hopefully you have enough information to be able to comment on the two tests I had after my biopsy, before my SBRT.
Please see below. (I haven't fully digested what they mean.)
Certainly, you know a whole lot more than I do, as you had been on this journey quite long. Many thanks for your help, and your many past comments in this support group that I found very helpful! -- Vir
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Nuclear Medicine BONE WHOLE BODY + SPECT + CT X2 PANEL
Collected on 21 Feb 2025 11:19 AM
Results
Impression
No scintigraphic evidence of osseous metastatic disease.
Narrative
CLINICAL HISTORY: Rule out metastatic disease from prostate cancer.
FINDINGS:
Delayed whole body planar imaging and SPECT-CT imaging of the chest, abdomen and
pelvis was performed.
There is no suspicious radiotracer uptake identified in the axial and
appendicular skeleton.
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CT ABDOMEN/PELVIS W C Collected on 02 Mar 2025 11:35 AM
Results
CT ABDOMEN AND PELVIS:
CLINICAL HISTORY: Prostate cancer. Rule out metastatic disease.
TECHNIQUE: CT images of the abdomen and pelvis following IV contrast.
FINDINGS:
There are scattered small hypodense nodules in the liver measuring up to 5 mm on
image 29 series 201 in segment 4. These are nonspecific.
Gallbladder and bile ducts are unremarkable. Pancreas is unremarkable. Spleen is
normal. Adrenals are normal. Kidneys are unremarkable.
Prostate gland is moderately enlarged and nodular. Bladder is moderately
thick-walled. Pelvic organs are otherwise grossly normal.
No dilated loops of bowel are seen.
There is no significant lymphadenopathy in the abdomen, pelvis, or
retroperitoneum.
No aggressive bony lesions are seen.
SUMMARY:
Enlarged nodular prostate. Moderately thick-walled bladder.TISSUE EXAM
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BIOPSY -- Collected on 24 Jan 2025 2:57 PM
Results
FINAL DIAGNOSIS
View trends
A. Prostate, Needle Biopsy Apex Left:
- Prostatic acinar adenocarcinoma, Gleason score 7 (3+4)
- 2 out of 2 cores are positive for malignancy
- Carcinoma involves 30 and 90% of the affected cores respectively
B. Prostate, Needle Biopsy Base Left:
- Prostatic acinar adenocarcinoma, Gleason score 7 (3+4)
- 3 out of 3 cores are positive for malignancy
- Carcinoma involves 80% of each of the cores respectively
C. Prostate, Needle Biopsy Apex Right:
- Negative for malignancy 0/2
D. Prostate, Needle Biopsy Base Right:
- Negative for malignancy 0/2
E. Prostate, Needle Biopsy Mid Left:
- Prostatic acinar adenocarcinoma, Gleason score 7 (3+4)
- 3 out of 3 cores are positive for malignancy
- Carcinoma involves 80%, 70% and 60% of each of the cores respectively
F. Prostate, Needle Biopsy Mid Right:
- Negative for malignancy 0/2

SYNOPTIC REPORT
TUMOR
Histologic Type: Adenocarcinoma (acinar, not otherwise specified)
Histologic Grade:
Gleason Pattern: Gleason pattern (specifiy)
Primary (Predominant) Pattern: Grade 3
Secondary (Worst Remaining) Pattern: Grade 4
Total Gleason Score: 7
EXTENT
Tumor Quantitation:
Number of Cores Positive: 8
Total Number of Cores: 14
Tumor Quantitation: Proportion (%) of prostatic tissue involved by tumor: 40
ACCESSORY FINDINGS
Lymph-Vascular Invasion: Not identified
Perineural Invasion: Not identified
Your value is PROSTATE GLAND: Needle Biopsy PROSTATE GLAND: NEEDLE BIOPSY -
All Specimens Procedure: Needle Biopsy
TUMOR Histologic Type: Adenocarcinoma (acinar, not otherwise specified) Histologic Grade: Gleason Pattern: Gleason pattern (specifiy) Primary (Predominant) Pattern: Grade 3 Secondary (Worst Remaining) Pattern: Grade 4 Total Gleason Score: 7 EXTENT Tumor Quantitation: Number of Cores Positive: 8 Total Number of Cores: 14 Tumor Quantitation: Proportion (%) of prostatic tissue involved by tumor: 40 ACCESSORY FINDINGS Lymph-Vascular Invasion: Not identified Perineural Invasion: Not identified
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One positive thing about your biopsy is that they only found cancer in the cores and no other negative discoveries. The thing is, 40% of your prostate has cancer and eight out of 14 positive cores is high for Gleason 3+4, to just figure the cancer can be eliminated. If they had your prostate out they might’ve been able to find more issues, since such a high percentage of the left side of your prostate was cancerous.

This makes me understand why the doctor wants to be careful about stopping ADT. If your PSA stays undetectable for the eight months after your surgery, then stopping ADT would make sense to try. If you had ultra sensitive PSA tests and it was .01 or less for six months I think that would be enough to show that it’s probably been killed, But I can understand the doctor wanting to be careful. Much worse to have it come back too soon.

I was on ADT for eight years so eight months is not a lot to have to contend with. Wish you the best, hopefully you can get long term remission.

Hey Vircet,
I was diagnosed with Gleason 3+4, no Mets, cancer contained to prostate. I had the same SBRT as you. I was on Lupron for 12 months and testosterone
suppression lasted a total of approximately 15 months. My PSA was undetectable approximately three months after SBRT And remained so until approximately 24 months post treatment. current PSA 0.34 and stable times nine months. this perspective helps and best of luck to you, my friend.

Yes, six months total here with Gleason 8.

Hey @vircet
I was Gleason 3+4 and my team had me on ADT (orgovyx) for 2 long years,

I had the surgery 9/21
then a recurrence 1/22 (.039)
ADT starts and IMRT salvage radiation 6/22
Orgovyx till 6/24

Hi @web265 How was (were) your follow up PSA test(s) after 6/24? I will have my 1st post-radiation PSA test in July, and then every 4 months after before my oncologist will advice if I can be off ADT. Thanks for your feedback,

@web265 I saw your reply in the other discussion topic (re: who is a good candidate for ADT holiday), therefore you don't have to repeat yourself here. I'm happy for you that your follow up PSA nos. are so low, they are considered undetectable. I am hopeful that in a year or two, I will also be off Orgovyx.