Big decisions regarding SRT and ADT for BCR

[shihtzu124]

My husband was had a robotic radical prostatectomy 1/2019 with no major complications or side effects. Gleason 4+3, negative margins and no positive lymph nodes. There was cribiform invasion of a nerve but all margins of the prostate and 0/13 LN were negative after surgery. His post surgical PSA was 0.01 and began uptrending a few years ago. It is now 0.17 on 11/2023. Was .06 on 6/2022. We are in discussion with a radiation oncologist at the University of Rochester who is recommending SRT along with 6 months of Orgovyx preceded by a Pet PSMA scan after PSA reaches 0.2. I am super nervous about both treatments as he is currently quite healthy and active. He enjoyed biking 1,000 miles last year and enjoys restoring our 200 year old colonial revival home. So current quality of like is very good. We travel to Florida for the winter and I would like him to get a second opinion at Moffitt Cancer center in Tampa. I am interested to hear about other folks who have had situations like his, particularly if you have had SRT and how you fared.

[Tall_Allen]

It is only 4-6 months. It would be over before the snow melts.

[Vortex12 in reply to Tall_Allen]

Just diagnosed. Gleason 8 Is there any way to avoid ADT if I choose radiation?

[Tall_Allen in reply to Vortex12]

It's up to you. But the data support improved outcomes in high-risk patients by combining ADT and radiation.

[Vortex12 in reply to Tall_Allen]

Can I do the radiation with 5 treatments, and ADT. I take it you are not in favor of surgery

Which radiation technique with ADT is the best?

[Tall_Allen in reply to Vortex12]

Vortex12, SBRT is still considered experimental for high risk patients, unfortunately. There are clinical trials, however.

The treatment that seems to have the best outcomes is brachy boost therapy. It consists of external beam radiation + a brachytherapy boost to the prostate (I recommend high dose rate brachytherapy) + 1 year of ADT.

prostatecancer.news/2018/03...

[Vortex12 in reply to Tall_Allen]

Thank you, making a note and will ask the Doctor for that

[Vortex12 in reply to Tall_Allen]

How do you get through the 1 year of ADT, sound like hell

[Tall_Allen in reply to Vortex12]

Not for most men, but everyone's different.

[Justfor_]

Post RP, it took me 2.5 years to reach PSA of 0.17, so, more advanced than your husband. My pathology ,also, confirms that (GS: 4+5=9, staging: pT3b, N0/20). But, I am also the odd one out here. Hence, I elected to kick sRT down the road by reverting to this:

healthunlocked.com/prostate...

Anyway, PSMA PET/CT before deciding on sRT is paramount IMO . Have been posting about this since the time SoC was: "You just don't need it". Happy to see now that some docs are starting to see the light.

healthunlocked.com/prostate...

[Lost_Sheep]

My situation matches your husband's...just 4.5 years difference in timing. Diagnosed April 2023, T3bM0N0. Intermediate Unfavorable. Biopsy 4+3=7 (March 2023). No detectable metastasis outside the gland by any scans, including a May 25, 2023 PSMA PET scan at Fred Hutchinson Cancer Center in Washington State.

After much research, discussion with radiation oncologists and surgeon, Dr L., I elected to take the slim chance (1 out of 7) that surgery would leave me cancer-free. (Feeling lucky and hoping that even if my gamble did not succeed completely it would buy enough time for medical science to find a better treatment than the "shotgun" -my opinion- approach of pelvic-wide radiation offered to me.)

I had to wait a bit for a consult with Dr L (reportedly the best the best surgeon for prostate cancer in my state - Alaska). We originally scheduled robotic surgery but we had to change to an open prostatectomy because the reservoir of my previously implanted penile implant was too close to the prostate gland to guarantee completion of the surgery. So, we switched to an open prostatectomy to be performed by Dr S. (who implanted me 5 years earlier). (Eventually, the reservoir was removed during the prostatectomy, to be replaced in a few months.)

I include this detail now just to show my earnestness for alternative treatments, but also my determination to NOT to forego or delay proven "standard of care" treatments. During the delays, and on speculation, I used a Rife machine I almost literally stumbled on (a friend was selling his deceased mother's household goods and it was laying in a corner on the floor). My PSA scores were: 60 days before, 12.0. 30 days before, 11.4. 1 day before, 13.0. So, that speculation was inconclusive.

I have not yet seen my pathology reports yet, but in our first post-op meeting, Dr S reported that he took the nerves on both sides of the gland, both seminal vesicles, extensive margins and a bunch of lymph notes. He suggested that in a few months some ADT (androgen deprivation therapy) and RT (radiation therapy) would be likely in my future...but we will see what my PSA is.

I announced that I REALLY want to consult with a medical oncologist with a more holistic/naturopathic approach to cancer. I have read hopeful reports of treatments on the horizon (e.g. Melatonin, Vitamin D, lifestyle changes, hormone-targeted chemotherapy, immunotherapy, etc). If cancer treatment by surgery is a club and surgery is a shotgun, I want a sniper rifle. Also, having this critical crossroad in my life is giving me motive to make changes in my lifestyle that hope to improve my health (e.g. exercise more, eat healthier -cutting sugar is particularly difficult and exercise will prepare me to minimize bone and muscle loss promised by ADT)

With your blessings, I will be following your husband's progress with great interest.

Thanks for posting.

[London441]

If you are aggressive with it now you have an excellent chance at eradicating it. The ADT helps the SRT do its job. SRT is very precise and should be no problem, and 6 months ADT is too short to worry about side effects.

Also the pill form wears off much faster.