Decipher Score and ADT

[Mike404]

I’m starting SBRT in a couple weeks at UCLA. I’ve posted elsewhere my stats. 62 years old, Gleason 4+3. 5/13 cores positive and large proportion of GG4, with cribriform. PSMA PET showed no spread, though the MRI stated there was possible ECE. So unfavorable intermediate, but close to high in some places.

My Decipher score came back low risk at .19. The thought is to conduct six months of ADT, which I can do with Orgyvyx/regulolix. Have anyone seen whether this low of a risk score would still require ADT? How manageable is four or six months, especially with Orgyvyx? Thanks

[Tall_Allen]

With your capsular extension (stage T3a), you should treat your case as high risk. (especially with a PSA of 15 (without finasteride))

Your low Decipher score is favorable, but doesn't take you out of the high risk category.

In the following clinical trial at COH, Cedars & USC, they are giving 2 years of adjuvant ADT to all high risk patients, but only adding Erleada for men with high Decipher scores:

clinicaltrials.gov/ct2/show...

I know Dr Kishan has a "high risk" SBRT clinical trial, where he optionally adds up to 9 months of ADT. Perhaps one can get away with 6-9 months if one is using SBRT.

[JWS13 in reply to Tall_Allen]

TA ..why can you get away with less ADT if u are using SBRT?

[Tall_Allen in reply to JWS13]

Maybe the higher biologically effective dose doesn't require as much ADT. We don't have comparative data however.

[1Ubspaine]

My prior diagnosis was almost mirrored yours and 6 months of ADT it was.

[Horse12888]

In my experience, a short course of ADT is easy to tolerate, and use of Orgovyx makes this even more so. Even if your SEs are terrible, you'll rest comfortably in the knowledge that you'll feel better soon.

[Hidden]

Seems like after six months the effects of ADT became more noticeable, at least it seemed that way to me. So 6 months would be tolerable.

[Mike404]

Any tricks on buying Orgovyx? I don’t think it’s FDA approved outside of an advanced cancer diagnosis. I’m assuming my insurance will reject it and I won’t qualify for financial assistance. They quoted me $2700 per month cash price. I’m assuming the rapid recovery makes it worth almost $20K.