Is drug treatment the only way to go?

[mickeypb]

Are my MO's doing the right thing? At 67, both Fox Chase and Moffit oncologists are of the same opinion that I should/can hold off starting any further treatment until doubling time is less than 6-9 months. Original PSA 7.4, Gleason 3+3, surgery 5/2007. Had slight PSA rise and had IMRT 3/2008. PSA still rising with the last being in May 2021 at 6.82. I have drops occasionally over the past 6 years, but have never taken or started any other drug therapy. MRI/CAT/scans show nothing. They say side effects of starting treatment now would involve the expected problems with hot flashes, bone-muscle loss, and less enjoyment in lifestyle without providing any real increase overall life expectancy. It's a tough call.

[Magnus1964]

My rule is get PSA tested at least every three months. If you get three PSA increases greater than 1.0 in a row, something is going on. I went decades without anything showing on a bone or cat scan.

I started ADT drugs at age 57. I do have osteoporosis at age 75, but consider the alternative.

[Hidden]

I agree with your oncologists. If you aren't seeing anything on scans, your PSA is low and the PSADT is long, there's no hurry to rush into treatment. It's not like you would be missing out on a potential cure.

You could probably hold off on starting ADT amd then do it intermittently as needed to manage the disease.

That's something to discuss with your oncologist. Wishing you the best.

[Justfor_]

PSMA PET/CT can shed some enhanced light into your condition.

[LearnAll]

First of all..Your Gleason Grade is 3+3=6 which is not even considered Cancerous. You are fortunate that your MOs are not pushing for treatments.You need to monitor at least 3 basic biomarkers.(1) PSA (2) PAP (prostatic Acid Phosphatase) and (3) Alkaline Phosphatase. I will monitor these once a month and chart a graph.

Then, to live treatment free for a long time...eat a lot of vegetables and fruits especially cruciferous veggies, Dark Red Grapes, Cooked Red Tomatoes , Turmeric. Ginger, Onion and Garlic....Preferably every day. Eliminate preserved meat and fatty foods. Physical exercise every day.

Hopefully, you may never need medical treatment for this condition.

[dac500 in reply to LearnAll]

I was diagnosed Gleason 3 + 3 ten years ago. Had brachytherapy. Then extra-capsular recurrence followed by multiple lymph node metastatic cancer. Now under ADT treatment. Don't tell me Gleason 3 + 3 is not cancer.

[Tall_Allen]

There's not a lot of evidence suggesting that starting ADT now has a benefit for men like you over waiting. GS6 is incapable of metastasizing as long as it stays GS6. It may not always stay GS6, but if it changes, it changes very slowly.

[Hidden]

You did not mention specifically psma pet. Have you had one of those? You were concerned enough to seek opinions from two different medical groups. What if the psma pet identifies a hot lymph node or two. You could potentially treat without adt, knock it back quite a bit, and reduce your stress. It just seems to me its in the back of your mind gnawing at you.

[garyi]

Fox Chase and Moffit are first rate and have fine oncologists. TA's comments are spot on.

IMHO, you are in good hands, and it's not a "tough call" at all.

[kaptank]

A PSMA(68Ga) PET every year or as needed would give you a good idea what is happening and where. PSA every 3 months. Look for the trend. As others say, no need to do much else at this stage. Exercise and good food (lots of opinions here!) are prescribed. My guess is yours is slow growing. Enjoy life!

[2dee]

Follow the SOC from a team you trust backed up by one or more second opinions.

2Dee

[Poowater]

After radiation to the prostate bed my psa dropped to undectable. Then it started rising very soon thereafter. Pet scan at low levels psa showed innumerable metastases in my bones. PSA 64. Started Zolodex, and it dropped immediately to 3. Has gone down steadily.

The side effects don't affect everyone. I had none, and I'm on it for life.

What you need is reduction in psa.You don't want it going to your organs.

[maley2711]

What was TA's bad news??? I don't seee it?

[Hidden in reply to maley2711]

i read his response wrong. I thought he was saying ADT was a treatment for Gleason 6 sometimes.

[maley2711 in reply to Hidden]

THANKS for confirming .....I've had my own share of misreading things!!

[Wdoug]

From personal experience, the side effects are well worth it. It was not fun but PSA is now good and I am as good as before although 5 years older, but alive and well.