when to start ADT for SBRT treatment of 4+3

Hi Laojia,
If you are getting SBRT/Cyberknife alone, it will be at substantially higher amounts. My SBRT at UCSF involved 2 treatment sessions 950 cGy x 2 and is considered 'boost' radiation to 25 EBRT fractions at 180 cGy. Stanford had earlier recommended that my boost radiation be HDR/Brachytherapy. However, I followed Dr. Roach's guidance and have attached his publication regarding the efficacies of both treatments.

I had gotten 5 second opinions from Urologists and ROs, however, I found particularly useful opinions from a friend who is a CMO and retired urologist who could speak freely and privately. I also considered a second from Mayo and Proton (vs. Photon) radiation, however, they required travel to Rochester (or another state) and I didn't find ample evidence to make the effort worthwhile. Proton has certain advantages, that you've likely read about, but so do several other treatment modalities that are being offered. I put a high value on the comfort factor of getting treatments and going to Stanford at 7a, before the traffic, is about as pleasant as a medical experience can get. By the end of my sessions, I felt like I'd made a new set of friends among the staff and was exchanging crab cake recipes with one of my radiation technicians.

For my case, these treatments, along with 4 months of Orogovyx, were as *minimal* as I believed would get the job done. I found my diagnosis, T1c (possible T3a based on MRI) M0N0 ISUP Group Grade 3
(Gleason score 4+3), to be ridiculously non-specific and had significant fear of over treatment. Of course, there are a variety of factors, outside Gleason scores, that further complicate and would make my reply too long for this discussion. In short, I wasn't convinced the risk/reward for SpaceOar, another procedure, would be worthwhile for me and, so far, that has been a good decision.

I am struggling right now with "fear of overtreatment". I have Gleason 3+4, one 1.5cm lesion, less than or equal to 5% pattern 4. 1 of 13 cores showed cancer. Cancer confined within prostate. PSA 8.5 on last reading. Prostate volume 100cc. PROSTOX test shows low risk for
greater than G2 long term side effects. Mayo Rochester radiation oncologist is advising SBRT of entire gland. I'm told I'm not a candidate for active surveillance because my Decipher Score is 0.78. I'm trying to assess if I'm a candidate for Focal Therapy and don't have an answer to that question yet. Some moments I feel like I'm hitting a thumb tack with a sledge hammer with SBRT. I don't know how to make this decision yet. Others have this challenge?

I could write volumes on why I feared over treatment given that nearly every indicator came with a set of 'qualifiers...think disclaimers'. At one point, I asked if they were using a Quija board to make my diagnosis. I do not want to recall all that trauma and will merely add that the one advantage PCa guys have is the slow progress of the disease that allows for quite a lot of time to get multiple second opinions and do research. It may not be the same for all/most insurers, however, for me there was no limit to how many second opinions and how many institutions that I could consult with. In the end, I went along with a fairly aggressive treatment, that addressed the 'possible Xs', e.g. T1c (*possible* T3a based on MRI). However, my plan was corroborated by many fine Drs. and research studies that I read giving me a moderate level of comfort in my decision.