I am a 60 year old recently diagnosed PC with a PSA of 11.3 and ultra sound biopsy grade cT1c Gleason 3+4 = 7 Right basal and 3+3 on Right medial only 2 of 12 cores contain cancer. MRI showed PI Rads 5 lesion in right basal peripheral zone and extension into right seminal vesicle. Chose to go with SBRT with 5 high dose treatments. Oncologist wants me to take Lupron ADT for 6 months during and after radiation treatment. I am really wondering how necessary the ADT is given my favorable intermediate risk factors given the PSA, MRI and Biopsy results? Any insight would be greatly appreciated; wanting to avoid potential recurrence but not liking the potential side effects from either the hormone therapy or the high dose radiation regimen.
Ultrahypofractional RT and ADT for In... - Prostate Cancer N...
Ultrahypofractional RT and ADT for Int. Risk PC
See the section titled "Favorable vs. Unfavorable Intermediate Risk" in this article:
prostatecancer.news/2016/08...
There are a couple of links to studies there that you may want to discuss with your RO.
Thanks for the quick reply and links. I am no doctor but it appears from the studies that if my biopsy and mri results are accurate ADT therapy is not going to benefit my long term outcome given my favorable intermediate risk categorization. Does that sound right or am I miss reading the study results or are there new studies that have been done that show benefit for patients like me doing 6 months of ADT along with the ultra hypo fractional treatment?
Please look at my profile.....my ADT with Orgovyx was essentially a piece of cake. And if it helps choke off the F'n cancer it is well worth it.
Oops!!! abbreviation alert, ring buzz ring buzz ring buzz!
F'n cancer = Fucking cancer.
Good Luck, Good Health and Good Humor.
j-o-h-n
Does your oncologist recognize you as favorable intermediate risk or is there some other detail about your stats that has him or her categorizing you as unfavorable? Is there something else the oncologist is concerned about, for example, the extension into seminal vesicle? Those are the questions I would ask since, if you are favorable, ADT wouldn't appear to be necessary or beneficial.
No other issues that I was made aware of regarding my categorization. I will ask again though since I would rather avoid taking the hormone therapy for six months if there is no benefit and many potential side effects.
Well I was under the impression that I was intermediate risk favorable but looking at the notes from the RO my last MRI results put me at stage T3b due to the intrusion into the seminal vesicle so it looks like the ADT along with SBRT is necessary to combat the PCa 😢
I know it's disconcerting to hear, but listen the folks on this site who've been through it, as they'll help to calm you and get you through it. And do ask the oncologist to walk you through the "why" again.
OMG OMG OMG..... a quick look and I though your UserID was NYC_Stalker..... Do you say DEM and DOZE instead of THEM and THOSE. To replay push 8 for Espanol.
Good Luck, Good Health and Good Humor.
j-o-h-n
I don't feel qualified to give direction but want to say that I had a similar diagnosis and dilemma, and opted for 7 fraction UHFRT with no ADT.
I did not have extension into a seminal vesicle, which would have caused me to think longer and harder about my decision.
I am older which is another variable in the mix.
Mark Scholz has recently produced a video on this very question, which may be of interest.
I empathise, and wish you well in your decision making process.
Hi, Another tool you can use to decide is the Myriad Genetics Prolaris Biopsy Report.
I did five treatments of SBRT with a similar diagnosis. I told the oncologist @ Sloan Kettering, New York City, Michael Zelensky (now @ NYU) that I was hoping to not do hormone treatments. He said, considering the fairly favorable decipher score that we would forgo it. Only time will tell if that’s the right decision. Sometimes I worry about it, but after almost 2 1/2 years the PSA continues to move slowly in the right direction. Best of luck to you.
Zelefsy (Radiation Oncologist).
Good Luck, Good Health and Good Humor.
j-o-h-n
agree with ToolBeltZia
Yep decisions, decisions and you have no idea what is behind door 2. I am a study of one but here is what I did with the same decision dilemma. Keep in mind I am approaching 80.
I did not have the option of SBRT so I had 25 doses of radiation. I had my prostrate and pelvic area done. I started ADT 2 months prior and did 4 months post radiation. ADT helps the radiation work better.
T lose and recovery maybe is your concern at your age. In my case my T recovered within two months of stopping Lupron. All side effects stoped and I could actually feel the T coming back. I attribute that to diet and exercise. I do resistance and aerobic exercise every day and continue to do that.
Coming up on one year out of radiation. After I post this I am going to get by blood work done. It will include PSA and T scores. Last PSA was done 3 months ago and it was .04 or.06 do not really remember exact number. No T number at that time. From what I can tell that is a good PSA level one year out.
I had minimal side effects with the radiation and ADT. Tough call but my rationale for my treatment was give it your best shot and hope for the best rather then piecemeal and nickel and dime it. My MO and RO supported that approach.
Good luck in what you choose. Hope this gives you some insight.
Do not take Lupron if you have any heart conditions. I have a replaced mitral heart value and the Lupron damaged my heart, so every heart beat the blood pushed through my heart was only 43% instead of 93%. I had trouble even waling up stairs. Once I stopped taking the Lupron, my heart returned to normal.
I would recommend that you heed your oncologist's advice, doing the Lupron for as long id deemed appropriate. When I was treated in 2017, I was on Lupron, Casodex and Avodart, (triple blockade) until my treatment was finished. Ok stayed on Lupron for a total of 18 months. I still take Avodart since my oncologist said that it helps to create a hostile environment for Pca. Seems to me that, for many patients, cancer cells may continue circulating in one's body for some time after treatment. I am still in complete remission 6 years after treatment for Stage 4 Pca.
"favorable intermediate" and all the rest of the numbers may really be meaningless if just one of those PC cells survives all the therapy you throw at it. The studies are clear. Unless you have one or more specific SE you're concerned about I would hit it with the biggest hammer I can and hope for the best. I've done surgery and RT w/ 6mo. ADT (Lupron) and I still don't know if the battle is over.
I have read all of the above posts and thinking about my own case , am sort of confused about what to look forward to . I had SBRT in July 2021 at the age of 81. Was a GS3+4=7 with a PSA of 19 when i opted for SBRT. At that time my RO recommended 3 months of Lupron and i rejected that or any other type of ADT. He readily agreed to no ADT in my case...I also have heart disease, T2 diabetes and Chronic Disease Anemia .,,so we proceeded without it. Post treatment my initial PSA was 5.0 and my most recent test 6 months ago was .57. Interestingly to me, along with my last PSA my RO ordered a T test ....first time i have had one in my life that i know of...and it was 300. From reading these posts it looks like 300 isnt all that low albeit not as high as we would all like. I feel very fortunate to have come through the SBRT with little to no SEs ,but the word libido hasnt been part of my vocabulary for quite awhile...sad to say. I still thank Tall_Allen every day for helping me navigate the decision process leading up to my treatment choice.
Am i correct to assume that had i undergone the ADT for 3 mos...my T level...and PSA levels today would probably be a lot lower than they are? I have next PSA test next week so I am hopeful it comes down a little more again. Im just happy Im still around at this point but my RO, who is a real pro at Emory Winship is treating my case like it is a nothingburger. I guess because of my age. But with a Prolaris report that wasnt great and being in the unfavorable intermediate classification, Just wondering what i might be looking at going forward. I have enough other active medical treatment problems and feel fortunate that my PCA has settled down since my treatment..at least so far. Personally, I have found regular rigorous exercise has helped me more than anything else. Best of luck to everyone!
Prostatectomy with pre-ADT?
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My urologist after RT and ADT
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