I was diagnosed with Gleeson 4+3 =7 around Feb 2014.
I had a radical prostatectomy in 2014,
Monitoring of my psa showed increasing levels; from 0.02 to 0.57 in Feb 2021.
So it took 7 years to get from 0.02 to 0.57
I commenced ADT treatment 3 months ago, July2021.
My PSA is currently 0.02, back to where I was 7 years ago.
My oncologist wants to commence radiation salvage therapy - 5 times a week for 7 weeks.
I am terrified of losing erectile function and 5% chance of rectum issues.
I’m considering stopping all treatment and just monitoring the situation.
I’m of a mind that if it took seven years to have the PSA go from 0.02 to 0.57, I should be around seven years away from reaching that level again.
I also have 5 stents and coronary disease : calcification of arteries - I don’t smoke or do drugs and drink occasionally and LOVE to exercise and keep fit. And figure the heart will get me before the cancer!
Does anyone have any thoughts as to just stopping all treatments and getting on with life???
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Granster62
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If you stop ADT, you can expect maybe 8 years without bone scan-detectable metastases. At that point the pain will only be relieved by hormone therapy, and you will probably die about 5 years later.
What about just radiation and no ADT? That might be a happy medium that sacrifices some but not all of OS time. Does radiation by itself really cause big erectile problems? I’ve had both and am still on a course of Lupron and just assumed the erectile problems were primarily caused by the Lupron. In fact, I can’t think of any problems that radiation have caused me that I noticed. Maybe in the future. They can use a space oar for rectal protection or just lower doses spread out longer, which is what I had due to a failed tulsa-pro that caused the prostate supposedly to be “sticky”. Probably should include pelvic so that its a last go round effort, if thats your mind set.
thank you magnus. we are at 3 month point post adt start but we are currently unable to travel for radiation for next 3 months due to an unrealated family situation. i am feeling paranoid that 6 months would be a little late to start radiation.
Definetly don't stop ADT. Your psa is low. I fail to understand why you need radiation. I had radiation with consequential bowel damage. Only get radiation if scans show activity.
The fact that your PSA rose very slowly 7 years is nice but no longer relevant, and banking on your logic that it will take that long again from this point is foolish.
Do you know what your cholesterol and triglycerides are? How much fat are you carrying? 95 kg at 185cms is likely overweight.
Has your body composition or weight changed since you got on the ADT? Your love of exercise is good, but you may be overselling your fitness level. Do you know your VO2 max?, your maximum heart rate, your heart rate recovery time after1 minute, 2 minutes or other?
If you are carrying substantial fat and have already had 5 stents, the heart disease is definitely more likely to kill you than the ADT. The problem is it may not take long.
We all have a limited time on earth ..... medicine & treatment is there to prolong this period as long as possible. IMO preserve your life & follow your Doc's recommendation's.
You already have beaten the odds by not losing erectile function with prostatectomy (the pessimistic numbers say as many as 50% lose erectile function). I am of the impression that the risk of loss of erectile function with Salvage Radiation is SIGNIFICANTLY LESS than with Prostatectomy & you have already beaten the Prostatectomy odds ..... IMO Preserve your life.
IMO 5% rectum issues with Salvage RT means 95% with no issues & you already seem to be a pretty good responder to odds.
If your cancer is isolated to the pelvis, pelvic (not just prostate bed) salvage radiation with ADT might cure you.
Do nothing & you likely shorten your life & die ...... sooner than you should.
Also, IMO, consider a dietary revolution in your life to delay or reverse your CAD (Coronary Artery Disease). Consider information at: nutritionfacts.org
I'm impressed that you can still get it up after 3 months on ADT.
ADT does have impacts to your cardiovascular system and you have issues there. So that would concern me personally and lean me toward listening to my oncologist with regard to salvage radiation.
I never recommend giving up and "getting on with life" though I admit to completely relating to the question.
Hell you got a stent, had RP. You don't seem the type to give up. As stupid as it sounds, or sounded to me at the time I was first diagnosed, there is more to life that sex but I still understand. And radiation is not a guarantee you will lose your ability.
See Tall Allen's comments. I assume he's using an algorithm to give you that info.
See London441's comment and pay heed as well. Assuming doubling time or growth would take another 7 years is indeed foolish.
Agree with RSCIC above. SRT including pelvic nodes when not demonstrably metastatic is an opportunity not to be bypassed. At your low PSA short term ADT, even just 4-6 months helps it work better giving better results. Because of your CVD antagonist ADT (Firmagon or Regulovix) should be used for The ADT and not Lupron or similar. Benefits outweigh the risks IMO. Good luck. Sooner is better than later in this situation.
My RO and MO both look for psa doubling time as a marker. Doubling time in this case is 3 months. Scans should be done at the lowest point as a benchmark then after doubling occurs.I have been told if psa hits 2.0 major treatments will be considered.
Me: diagnosed in 2015 with psa 20.62. IGRT 25 sessions after being on monthly Lupron for 2 months. The 2 sessions of salvage hdr brachy. psa after all that 0.51.
Presently on monthly Lupron and 6th month of Nubeqa. Psa presently 0.03.
But remember this we are all different. Cancer is just a word; Not a sentence.
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