Treatment going forward

[good2go]

Boyfriend is 73 was on AS after TRUS bx with decipher score 3.0. Bx 3+4 after downgrade from JH.

Now one year later Saturation Biopsy reports 3+5=8 one core and 4+5=9 two cores between 5 and 20% pattern 5. PSA remains about 3.4. Total of 9/30 positive mostly 3+4=7 20% pattern 4.

PSMA PET/CT reports focal uptake at left posterior margin of prostate non-specific possibly correlating with primary imaging. Max SUV is 3.4. MRI shows indistinct margin Pirads 5 with 25mm mass posterior lateral to mid lateral left side . Prostate size was 39 now 66cc per MRI.

We will be meeting with a team of four female doctors at Fred Hutch Seattle next week.

Is avoiding ADT a possibility in light of the encouraging PSMA PET? Any treatment suggestions? Any MD recommendations in the Seattle area.

Thanks

[Tall_Allen]

He absolutely needs adjuvant ADT. He can have 2 years of ADT if he opts for external beam only radiation, or 1 year of ADT if he has brachy boost therapy:

prostatecancer.news/2022/01...

He should also consider widening the field to include pelvic lymph nodes:

prostatecancer.news/2021/08...

[good2go in reply to Tall_Allen]

TA Thanks. Looks like we are getting a personal trainer and changing the retirement plan to a fun fitness adventure for the next couple of years. I was hoping to hear you say this could be treated as intermediate grade with cancer localized to the prostate even though approx 20% PSMA risk of missing small lymph node involvement.

[Tall_Allen in reply to good2go]

GS 4+5 is high risk. PSMA only detects 5mm+ tumors. You have to use the Roach formula.

[addicted2cycling in reply to good2go]

As a 5+5 in 2015 and 5 months +1 day from my 74th Bday, I'll give a 👍to T_A's -- 1 year of ADT if he has brachy boost therapy + also consider widening the field to include pelvic lymph nodes.

[good2go in reply to addicted2cycling]

Thank you both. I realize we are talking about life saving protocol. Onward...

[vintage42]

"... Is avoiding ADT a possibility in light of the encouraging PSMA PET?"

I avoided ADT after external beam in 2021, and blame that uninformed choice for cancer now remaining in the prostate and spread to two nodes. I finally started ADT with Orgovyx two months ago and have no side effects.

[good2go in reply to vintage42]

In response to Vintage 42 and the others, Thank you. Just hearing from others makes me feel so much more prepared for the rocky road ahead. Honey is out golfing now as he does MWF with the Men's Club. At 73 he is one of the younger guys and says "they have all been through it". One buddy is out there and he has had a double lung transplant. On Thursday he will see his team at Fred Hutch Seattle. KGC 137 thanks for Dr Sunkara's name. It changes the dynamic knowing a thread of familiarity. To J-o-h-n, the answer is no he didn't request a harem but he is used to his bunch at home with me and the two kitties. I'll have to let him have his fun with the girls. London 441. At 73 he is showing some muscle decrease and a firm round (basketball) tummy. He does have a six handicap but not a sixpack abdomen. He played in the rock pile for twenty years as a local stone mason and that helped build strength. I hope I don't see it melt away. I remember he called his job birth control because after laying brick all day... And to Almost no Hope 3+4 were the good old days. Best to all. T+L

[London441]

Avoiding the ADT with his pathology not recommended as noted! The ‘fun fitness adventure’ is wise.

Is he fit now? The more fit and strong he is going in the better. Combining both cardiovascular and weight training is a supremely effective antidote for ADT side effects.

[AlmostnoHope]

With a 3+4? Do t let them scare you. Ridiculous.

[tsim in reply to AlmostnoHope]

Reading is fundamental

[j-o-h-n]

Did he request for "four female doctors"? If so, keep your eye on him..........

Good Luck, Good Health and Good Humor.

j-o-h-n

[Teacherdude72]

With a Gleason score of 9 absolutely need ADT. The highest Gleason score is the one always used for treatments. Gleason 9 is always considered Aggressive

[kgc137]

I can recommend Dr. Rajitha Sunkara, who was at Dana-Farber, but just started a position at Fred Hutch (Oct. 23) . I was a patient of hers for a few years.