My RO Wants Me to Do_ADT, HDR & EBRT

[Arthro92]

hello,

i'd like some help from all who's willing. my RO called and told me that my PSA is 18.67. so in addition to HDR, he wants to add eligard and EBRT. what has me so confused is, when looking at the results of my bone scan, and MRI, there's no evidence that the cancer has spread outside of my prostate. so, based off my research [my gleason score by the way, is 4+3=7; 3+3=6 grade 1 on my 2nd opinion] it doesn't seem like i would need hormone therapy. i was also told that EBRT is normally used when the cancer is outside of the prostate. mine is still localized. can some1 please help me to understand?

with my research, hormone therapy has a negative impact on muscle mass and will make you gain weight. i was born with a disability that as a result i don't have a lot of muscle mass as it is and i can't build it like the average man. not to mention the fact that i weigh 168lbs. i can barely walk 500ft. without feeling pain in my hips and lower back from this weight i'm carrying. another SE i read about is what it does to the bones. my disability is bone, joint and muscle related. i'd B in a wheelchair trying to carry all of that weight gain, plus what if i fall? how much easier would it be to break or fracture a bone?

i know it's not guaranteed that i will experience all of the symptoms, but if i get that shot it'll be inside of my body for six months, there's no telling how long it'll take to leave my body. someone suggested casodex. but again, if my prostate gleason score is 4+3=7 at first diagnosis, 3+3=6 grade 1 on my 2nd opinion, plus there's no evidence that the cancer has spread outside of the prostate, why even do hormone therapy.

my signature

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D.O.B. 1973

07/14 PSA 5.5

08/14 TRUS Bx Prostatitis & BPH

07/15 PSA 5.9

01/16 PSA 7.6

03/16 PSA 6.2

07/16 PSA 6.9

10/16 PSA 6.9

03/17 PSA 7.2

05/17 3T MRI Good

11/17 PSA 7.7

11/18 PSA 10.8 Cipro for 2 wks

07/18 PSA 11.9

08/18 3T MRI: 3 per ZN focal ABN, 1 with a PI-RADS 4 lesion & 2 with PI-RADS 3 lesions. No extra PCa disease, pelvic LAD, or pelvic lesions

02/19 MRI fusion biopsy

Bx Findings

A. PROSTATE, LESION 1, LEFT APEX, 3D MRI FUSION BIOPSIES: * BENIGN

B. LESION 2, RIGHT MID GLAND *PCa, GS 4+3=7 (GRADE GRP 3) 3 OF 3 CORES

(95% DISCONTINUOUS, <5%, <5%) * GS GRADE 4 60% OF THE TUMOR

0 PERINEURAL INVASION IS PRESENT

INFLAMMATION.

C. LESION 3, DIFFUSE LEFT MID GLAND, 3D MRI FUSION NEEDLE CORE BX's

PCa, GS 3+4=7 (GRADE GRP. 2) LESS THAN 5% OF THE FRAGMENTED CORES

GS GRADE 4 INVOLVES 5% OF THE TUMOR

2nd Bx OPINION

A. Benign

B. PCa, GS 3+3=6 (Grade Grp. 1) 80% of 1 core

C. PCa, GS 3+3=6 (Grade Grp. 1) 20% of 1 core

Considering options

[Magnus1964]

ADT before radiation is standard. It works on any cancer that may have left the prostate, and weakens any in the prostate making the radiation more effective.

It appears you have a low grade Pca. However you are young to have Pca. This may be something you will be battling for a long time. If you can kill it of completely at this stag would be great.

[Tall_Allen]

I think you have to first resolve whether the increase in PSA is due to prostatitis or PCa. You may want to wait before deciding.

[Arthro92 in reply to Tall_Allen]

i would you recommend i resolve that? how would i get my RO and MO to resolve that?

[Tall_Allen in reply to Arthro92]

By waiting for the inflammation to go away and retesting. Prostatitis tends to go away and come back. You already know you have chronic prostatitis. The only reason he is recommending treatment now is because of your elevated PSA, which doesn't seem to be attributable to Epstein's reading of your biopsy results.

[Arthro92 in reply to Tall_Allen]

only in general, which opinion should a patient go with: the 1st. diagnosis or the 2nd. opinion? oh, and how will i know when the inflammation goes away?

[Tall_Allen in reply to Arthro92]

Epstein's opinion is the gold standard

If the inflammation goes away (it may not), PSA will probably go down

[Arthro92 in reply to Tall_Allen]

is there a way you and i can stay in touch privately?

[Tall_Allen]

I sent you a PM

[FCoffey]

If you go to an RO they are likely to recommend radiation. Your history shows a pretty slow growth, it took about 5 years for the PSA to double. With slowly rising PSA and a Gleason 6 score watchful waiting / active surveillance is an option you should consider carefully. See at least three more doctors, MOs and Uros, before you do anything drastic.

[dadzone43]

"If your only tool is a hammer, everything looks like a nail."

Your RO will recommend radiation. That is his hammer.

The oncology studies show (in populations) a "significant advantage" of adding ADT. Another hammer.

Oncologists whether medical, radiation or surgical are good people with only one metric: survival. When I ask mine for specifics of significant advantage it gets a little vague. 21% lived longer (while 79% did not). How much longer? Well we don't have that information from these studies. Obviously I have not talked to more than three oncologists. And they all work together on the same team and have the same mind-set. That said, I find them really dismissive of the side effects of the treatments they offer. Well "a little lifestyle adjustment should handle most of them" was the response I got. How does lifestyle adjustment handle brain fog, memory loss, depression I wonder. How does lifestyle adjustment reverse muscle loss, bone loss, fractures, increased body fat, increased atherosclerosis? Easy for you to say, doc.

Population studies do not apply to you, Arthro92. You have some unique genetics that quite rightly are making you question what might be the effects of the proposed treatment on your overall health, on your mobility and on your quality of life. None of us on this forum can even begin to understand the difficulty of that decision for you.

I cannot either. But I get it and I want to support you in your determination not to rush to a treatment that could be catastrophic for your health but help you live longer. It might not be the best trade-off. Best regards.

[Arthro92 in reply to dadzone43]

thank you, dadzone43. i still don't know what to do. last night, i found out about proton therapy. but i'm not sure if there's any research for using proton as an alternative to HT. one guy suggested taking casodex alone for six months then HDR. so, i don't know. i'm going to ask more about proton therapy and talk with my MO tmrw and C what he has to say.