? for Tall_Allen

[Scooter22]

Opinion? I was diagnosed Intermediate unfavorable, 4 core samples 4+3 & pirad 5 lesion. Extracapsular extension identified by John’s Hopkins. Rapid rise in psa from 6.4-19 within a yr.. Pet scan Showed no metastasis so localized disease. My radiation oncologist recommended 4 mos. Adt starting 4 wks b4 my initial sbrt treatment. I started Orgovyx in Oct. & began my sbrt in Nov, finishing at Thanksgiving. In the meantime I decided to consult a medical oncologist at Duke & he proceeded to tell me that considering my psa & level of disease he usually recommends 2 yrs of adt. I saw 1 of your previous posts stating adt usually not needed except for high level disease. What do you think about the treatment suggestion discrepancies between my 2 drs.? Thanks.

[Tall_Allen]

If you are "high risk" 2 yrs of ADT is reasonable. If you are unfavorable intermediate risk, 4 months is reasonable. If there was "extracapsular extension" you are "high risk." You may want to see if you can get a Decipher genomic test of your biopsy cores to help you decide.

[Scooter22 in reply to Tall_Allen]

Ok, thanks

[j-o-h-n in reply to Scooter22]

Get a third medical opinion to break the tie........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/24/2022 3:08 PM DST

[Scooter22 in reply to Tall_Allen]

I have read in my personal “research” on the subject of adt for my level of disease that there is very little evidence that there is any benefit to the therapy past 18 mos. ?

[Tall_Allen in reply to Scooter22]

I think you are referring to Nabid's PCSIV trial comparing 18 months with 3 years of ADT.:

europeanurology.com/article...

In that trial, only about half of the cohort in that trial who were supposed to get 36 months of ADT actually got that much. And nearly a quarter of the 36-month cohort actually received less than 21 months. The only data we've seen so far has been analyzed by the dose they were intended to get, not by what they actually got. Also, why were the drop-out rates so high?

Here's my best evidence:

prostatecancer.news/2022/01...

[Vynbal]

I was in a similar position as you. My PSA/Gleason etc classified me as UIR, but I also showed evidence of ECE on MRI. My RO said ECE means High Risk, i.e. 2 years ADT. My MO said the MRI ECE was equivocal and said I should be treated as UIR, i.e. 6 months ADT. They agreed the case fell in a grey area (my decipher score was 0.54, not particularly helpful one way or the other!) and sort of left it up to me if I wanted to be treated more aggressively or not.

[Mgtd in reply to Vynbal]

So what did you do?

[Vynbal in reply to Mgtd]

6 months of Orgovyx. That ended 2 years ago. So far my PSA has stabilized to 0.4