Here we go.......

[ToolBeltZia]

FULL DISCLOSURE, LONG POST

Had a TRUS biopsy end of September after AS of a rising PSA. Had a 3T MRI in November 2021 which showed a PIRADS 3 left base and PIRADS 2 right mid, prostate volume 40mL. 4K in August of this year was 57.1 with PSA of 7.8.

DICIPHER from biopsy was .84.

Clinical stage T1CN0M0 negative DRE. On the cusp between intermediate favorable/unfavorable with 4+3=7 tipping me into unfavorable.

Local path report significant findings:

A) PROSTATE, LEFT BASE, BIOPSY: Histologic Type:

Prostatic adenocarcinoma

Histologic Grade: Gleason's grade 4 + 3 =7

Grade Group: 3 (of 5) Cribriform Pattern: Present

Tumor Volume:------

Number of cores positive: 1

Total number of cores: 2

Total linear mm of carcinoma: 4.2 mm

Total linear mm of needle core tissue: 25 mm

% of prostatic tissue involved by tumor: 17%

B) PROSTATE, LEFT MID, BIOPSY:

Histologic Type: Prostatic adenocarcinoma

Histologic Grade: Gleason's grade 3 + 3 =6

Grade Group: 1 (of 5) Tumor Volume:

Number of cores positive: 1

Total number of cores: 2

Total linear mm of carcinoma: 1.6 mm

Total linear mm of needle core tissue: 25 mm

% of prostatic tissue involved by tumor: 6%

F) PROSTATE, RIGHT APEX, CORE NEEDLE BIOPSY:

Histologic Type: Prostatic adenocarcinoma

Histologic Grade: Gleason's grade 3 + 3 = 6

Grade Group: 1 (of 5) Tumor Volume:

Number of cores positive: 1

Total number of cores: 2

Total linear mm of carcinoma: 0.5 mm

Total linear mm of needle core tissue: 20 mm

% of prostatic tissue involved by tumor: 3%

Mayo path report (second opinion)

A) Prostate, left base, needle core biopsy:

- Prostatic adenocarcinoma.

- Type: Acinar.

- Grade Group and Gleason score: Grade Group 3 (Gleason

Score 4+3=7).

- Percentage of pattern 4: 50-75% Tumor involves 17% of overall specimen (1 of 2 cores). Most affected core is involved by tumor over 30% of its length. Perineural invasion is identified.

B) Prostate, left mid, needle core biopsy:

- Prostatic adenocarcinoma.

- Type: Acinar.

- Grade Group and Gleason score: Grade Group 1 (Gleason Score 3+3=6).

- Percentage of pattern 4: NA Tumor involves 6% of overall specimen (1 of 2 cores). Most affected core is

involved by tumor over 15% of its length.

- Other findings: Atypical cribriform proliferation, suspicious for intraductal carcinoma.

F) Prostate, right apex, needle core biopsy:

- Atypical small acinar proliferation, suspicious for adenocarcinoma

PSMA PET end of October shows PC confined to prostate and only on left side.

After meeting with Uro and radiation oncologist I am moving forward with RT. I believe I will have a better quality of life with RT, and if the Pc returns in 12-15 years I believe new treatment modalities will be available.

Treatment will be SpaceOAR, SBRT with focal boost and urethra sparing, 5 sessions over two weeks and ADT for 6 months as I am intermediate unfavorable. Prophylactic Flomax.

Main concern is looking, feeling and acting like a little old man from ADT, and I am not ready for that. But it is only for 6 months……. One percent of my adult life……Going with Orgovyx over Lupron as it avoids the testosterone spike, reached castration level suppression much faster, has less cardiac toxicity and testosterone levels return much more quickly at the termination of therapy. And…it puts me in control as I choose to take the pills….it is important for me to feel some modicum of control on this rollercoaster.

I am 68, active and in good shape.

My Pre-ADT workout (basically the workout I have had for years)

Three days a week:

25 pullups

20 minutes fairly intensive elliptical (heart rate 140-150)

15 minutes planks, Russian twists, dead bugs, leg circles

35 minutes weight machines

10 minutes stretching

Walk 18 holes of golf once a week.

Three to five days a week walk 3-4 miles.

Dumbbell workout 2-3 times a week.

I intend to keep this workout and watch portions and calories (cutting sugar and carbs) to combat weight gain, bone density and muscle loss.

Having the SpaceOAR and fiducials placed on Thursday, simulation workup following week and likely start SBRT after Thanksgiving.

I will report back along the way.

Good luck to all of us, keep fighting the fight, and Fuck Cancer.

[conbio]

Best of luck. I chose (G 4+5, limited to prostate, 67yo) EBRT, Brachy, and 18 months of ADT. Yea, it was kinda a pain for that long a time - mainly hot flashes were the issue. Pretty active climber, mt biker, backcountry skier.

Took on a trainer once a week over 2 years to learn lifting and wow! Did I get schooled. Lots of exposure to basic strength and dynamic strength workouts. And you cannot push yourself like a trainer will. Any-who - my suggestion is to work with weights 2x a week, once with a trainer. It kept me sane and kept up my strength.

Now, 6 months post ADT - testosterone back up to normal as is RBC/hemoglobin.

You sound motivitate - you'll get it.

Saw bumper sticker on big truck the other day - FUCK CANCER - LET'S GO FISH

[ToolBeltZia in reply to conbio]

Congratulations on being 6 months post ADT, and thank you for sharing. I have been fortunate to have a fairly easy ride health-wise for 68 years and it is time to fight for a bit. We got this. Thanks Brother.

[paladin7 in reply to ToolBeltZia]

It sounds like you are setting the stage for success! Keep up your excellent exercise regimen. I was on androgen deprivation drugs for a year. I had a couple of scary cardiac "events" with prolonged periods (once for 20 minutes) when my heart rates was ~ 110, while resting in bed! Normally it is in the low 50s. But a year later, I had my heart checked out due to another condition, and it was fine: no damage at all. The hot flashes didn't bother me, in fact, I thought they were amusing. I had no libido while on the drugs, but it returned gradually afterwards. So, all things considered, ADT was not as bad for me as I had been led to believe. I have a feeling you will be fine. Good luck!

[ToolBeltZia in reply to paladin7]

Thank you Brother. "Amusing" hot fashes.........great attitude!

[Hidden]

A man with a plan...and a good one at that! Good luck to ya!

[ToolBeltZia in reply to Hidden]

Thank you Brother.

[cybertreated2019]

I had largely the same treatment “sans the ADT” for favorable intermediate PC in 2019 with SOAR and SBRT. I took low dose cialysis for 30 days before and 90 days after treatment to preserve function and alleviate BPH issues. Worked for both.

God speed to you.

[ToolBeltZia in reply to cybertreated2019]

Thank you. Sounds like you are doing well , keep it up (pun intended)

[dlste353]

You are definitely a winner. You have a great plan that you have thought through well. Orgovyx is a smart choice. You will not look and feel like a little old man especially if you keep your exercise regimen up. I’m in my last six weeks of 18 months of orgovyx and while I won’t say it’s been easy, I definitely feel better the more I exercise. Good luck!!

[ToolBeltZia in reply to dlste353]

Thank you Brother. Just had SpaceOAR and fiducial placed today with general anesthesia. We will see how I feel tomorrow, but tonight I have to take the Doc s word that he did anything. No pain or discomfort.