when to start ADT along with SBRT

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laojia
laojia Member Posts: 6 Member
edited June 28 in Prostate Cancer #1

Hi, due to scheduling delays I won't be able to start SBRT (cyberknife) for my Gleason 4+3 multi-focal PC until September. My PSA jumped in October last year from 2.7 to 4.6 in 16 months time. I did not get a biopsy until April which shows two localized tumors about 1 cm each. 70 percent gleason pattern 4.
I would like to start a 4 to 6 months ADT asap to prevent tumor further grow/spread. However the radiation oncologist insists not starting ADT until after SBRT treatment for better effect. I have read that ADT should be started 2 month before radiation in order to weak the tumor cells before radiation. I am right?

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  • Clevelandguy
    Clevelandguy Member Posts: 1,087 Member
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    Hi,

    I guess there is no gold standard on before or after. Some sources say before, some say during, some say after.

    Dave 3+4

  • Old Salt
    Old Salt Member Posts: 1,420 Member
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    I believe that you are correct (starting ADT prior to radiation).

    I can also state that this was the protocol at Georgetown U radiation oncology where I had 'double' radiation therapy (SBRT first followed by IMRT).

  • Steve1961
    Steve1961 Member Posts: 587 Member
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    have you had decifer testing yet to make sure the Gleason 4 is not Cribiform ..cribiform is radiation resistant ,,trust me i know it happened to me .. six years later, I had a reoccurrence and now I am recovering from salvage surgery. The Gleason 4 remained in the prostate. The radiation did not kill it. It wasn’t a new tumor. It was right there next to the marker. I had two surgeons tell me that they’re finding these days, that cribiform is radiation resistant so I would make sure that it’s not Cribiform form if I was you

  • laojia
    laojia Member Posts: 6 Member
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    I did have a decipher test which shown a score of 0.43, barely in the low risk category. the report did not mention Cribriform present or not, neither did my biopsy report. I asked a respected urological oncologist (Maxwell Meng at UCSF). He told me if there's no mention in the report, then it means "no" cribriform. The biopsy report did say "The Gleason pattern 4 types identified include poorly formed and fused gland types with mucinous features". I guess that is different than cribriform?

    The decipher report did say:" if treated with radiation alone without concurrent hormone therapy, the patients have favorable outcomes". However my two tumors, one has 70% pattern 4, another 80%, solidly in the Unfavorable Intermediate risk category. I don't know if I can skip ADT even if decipher is border line low.

  • Old Salt
    Old Salt Member Posts: 1,420 Member
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    You should inquire how long the ADT would be for your case. Typical scenarios are 6, 12 and 18 months.