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When to start ADT treatment of 4+3 score?
Hi, due to scheduling delays I won't be able to start SBRT (cyberknife) for my Gleason 4+3 multi-focal PC until September. My PSA jumped in October last year from 2.7 to 4.6 in 16 months time. I did not get a biopsy until April which shows two localized tumors about 1 cm each. 70 percent gleason pattern 4.
I would like to start a 4 to 6 months ADT asap to prevent tumor further grow/spread. However the radiation oncologist insists not starting ADT until after SBRT treatment for better effect. I have read that ADT should be started 2 month before radiation in order to weak the tumor cells before radiation. I am right?
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I started mine 2 weeks before SBRT. Gleason 4+3, 6 months Orgovyx for my ADT
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1 ReactionI am a fellow PCa patient. My care team wanted to start ADT 4 to 8 weeks before EBRT. We started RT 7 weeks after ADT started (Orgovyx and Zytiga) and confirmed that PSA became undetectable before 33 sessions of VMAT IMRT started.
Best wishes for success on your journey.
Extraprostatic extension (EPE) is a factor in determining pT3a stage in prostate cancer. Unfortunately for me I had EPE and needed to have ADT after radiation.
If you don’t have EPE it is worth a discussion about next steps.
Regardless of the treatment we all can face biochemical reoccurrence.. rely on your oncologist for advice..
In my case, 3+4=7, localized and Intermediate risk, my urologist and RO both agreed that a six month course of Eligard should start before my SBRT treatment (True Beam STX). Both, as the OP suggested, wanted the ADT to starve and weaken the tumor cells so they'd be more amenable to radiation. So I had my ADT shot on February 14 2024 (love the irony of a hormone shot on Valentines Day ;-)) and I started radiation in May, with the final 5/5 fraction on May 17.
The specifics of your case may dictate your RO's preferred course of action, and/or that's how they were trained and are most comfortable with that treatment plan. I don't know if there is any reliable research suggesting one approach or the other, but it's worth understanding your RO's thinking. And you may want to consider a second opinion too. If I've learned anything in this journey it's that self-advocacy is a necessity, and that may not always be easy when we're talking to "the experts". Best of luck to you, and warrior on!
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1 ReactionThank you, Scott, for sharing and kind encouragement. When it come to seeking treatment from a large University medical center (in my case, it is UCSF). It is very daunting to book consultation, tests, etc. Long waiting time is very frustrating when you might have a deadly disease. I found a urologist on line when I had an elevated psa, but after meeting him I didn't like his communication style as well as the fact that he even did not perform the DRE. So I went UCSF to book fusion biopsy and other tests and consultation with urology oncologist and radiation doc. Everything is 2 weeks to a month waiting. There's only one doctor there inserting spaceoar, the waiting time is more than a month....
That’s about when I started and received my first two of three shots. Two of Firmagon, one Eligard. I also had SpaceOar gel inserted before as well. Other than some minor side effects, I am doing well for one year out. My latest PSA was .21. I was stage 1 intermediate Gleason 4+3/7.
Stay strong.
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1 ReactionStarted Orgovyx one month before SBRT. Came off 5 months after SBRT with a 0.05psa.
Good luck. The anxiety is way worse that the ADT/SBRT treatment.
Hang in there
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1 ReactionI was also 4+3=7, trimodal treatment: Cyberknife and EBRT and started Orgovyx 6 weeks ahead of SBRT, and took it for 4 months. According to my RO, maximum effectiveness, shrinkage of cancer and slowing tumor growth, is at 6 weeks.
You should be able to find ample data on this topic.
You'll want to go on and off Orgovyx asap. I'm still having side effects 5 months after completion. They are minor, but, I want to be back to 'normal' as much as possible.
I had the majority of key treatments at UCSF, even though I can walk to Stanford, and my RO is the best. SpaceOar is controversial. Some institutions, like Mayo, tend to recommend for everyone. I like to review and evaluate every aspect of treatment, dependently and independently, of the institution as they all have biases and directed protocols. We discussed SpaceOar and I agreed not to have it as there are some risks. I have no regrets now. Overall, UCSF was easy to work with, friendly and the Valet Parking at Mt. Zion is unbeatable.
I'm presuming you had a Decipher Grid, post biopsy. My treatments were split between the Stanford and UCSF and I still see technicians and Drs. from both.
Seasuite,
What prompted you to do both EBRT and SBRT? Isn't either one would be effective for 4+3 PC? Do you think SpaceOar is only marginally beneficial? That was my RO told me: he did not recommend SpaceOar, but if I want it then he would order it. I know the GU risk without SpaceOar is only 3 to 4 %. However Dr. Mark Sholtz from Youtube highly recommend spacer inserted.