SBRT with ADT or no ADT

Heff

Hello, I have been diagnosed with localized prostate cancer this past summer . PSA 7.2 Gleason 3+4 .decipher 0.49 My Father died of Prostate cancer 2007 at 72 . I am 66 . I have decided on SBRT rather than Radical Prostatectomy . The oncologist suggested ADT ( Androgen Deprevity Treatmant ) or I can decline at this time . Looking forward to hearing from those who have had experience with this . I really do not want to go through the hormone therapy .
Thank you . Heff

capecodder

Heff- I am almost your clone in terms of PCa situation. 66 yo, father with PCa, diagnosed last Dec with 3+3, low PSA of 2.0, history of BPH that has been treated well with Cardura and Gemtesa (helps with overactive bladder) so I only pee 1-2x per night. Upgraded to 3+4 (10% of one core had 4) in late August from confirmatory biopsy at Dana Farber in Boston. Learned I also carry CHEK2 gene this summer, and just got DECIPHER score of 0.54 in mid-November. Doc feels I should start some treatment in next few months. Was leaning towards surgery as I am otherwise is good health and think I would recover well, understanding the potential of incontinence and ED for a while (possibly long while). I just want the cancer out and like having the option of radiation if there is recurrence after surgery. However, I spoke with a radiology oncologist from Dana Farber this morning, and he gave me more confidence in SBRT. He said he does not think I would need ADT at this point. I am also worried about possibility of other cancers from radiation, like bladder or rectal cancer, but he said chances are < 0.5%.

Interested in your thought process to choose radiation over surgery. I will also read the responses you receive from others since we are in similar situations.
Thanks.

swl1956

I'm fairly certain ADT will significantly improve your odds for a better outcome when added to radiotherapy of any type. I've been on relugolix and abiraterone + prednisone for about a year now. Prior to treatment my PSA had reached 9.3 with a 4+3 Gleason score. I was started on ADT a couple months prior to my 40 IMRT treatments. Once determined that metastasis to pelvic lymph nodes had occured it was a no brainer for ADT which I'm supposed to continue for a total of 2 years. The ADT in my case hasn't been all that bad so far. The occasional hot flashes are annoying but very tolerable. Fatigue and dry skin are my biggest complaints. In your case with a family history of Pca, I think you should seriously consider ADT. The SBRT should be very easy to tolerate with perhaps only 5 sessions. Talk to your doctor about perhaps a shorter coarse of maybe 6 or 12 months of ADT. My PSA for the last nine months has been in the undetectable range. 😀 My journey started out as a medium risk of metastasis. I had all the tests. MRIs, two biopsies, bone scan, genetic test, PSMA PET scan, all of which concluded the cancer was contained in the prostate gland. I chose a Focal therapy which I was told I was a good candidate for yet 6 months later Pca had metastasized to pelvic lymph nodes. If I could go back in time, I would have insisted on ADT right from the very beginning. In most men it's very effective at halting spread and reducing tumors.

Clevelandguy

Hi,

A lot of doctors want you to take ADT before your radiation to weaken the cancer as a standard method. As a lot of people can attest to, depending on the type of ADT drug it can be rough on you. Mood swings, hot flashes,weakness due to muscle mass loss, ect. From what I have heard there are some newer ADT medications that lessen some of the side effects and even daily pills instead of injections. Surgery is a good alternative to radiation with different side effects. Capecodder is spot on with his analysis. I had surgery 11 yrs ago and don’t regret it knowing I have several good backups if my cancer returns, ie; radiation,Proton radiation, maybe ADT(I said maybe). Always have a future plan before you make your decision. Surgery after radiation is usually a little more tricky because the radiation has shrunk you Prostate . If you choose radiation check into putting a gel between your Prostate and Rectum to protect your Rectum from radiation damage. If you choose surgery there is a new one entry point robotic surgery that preserves nerve function better than my 5 port procedure I had 11 yrs ago. Get the best doctors + facilities to get the best results. Its your body that will live through your decision so study and you will come to the right conclusion for you. Good luck. I have included a link for you to study.

https://www.cancer.org/cancer/types/prostate-cancer/treating.html

Dave 3+4

swl1956

Heff,

These videos might be helpful if you haven't seen them already.

https://youtu.be/ryR6ieRoVFg

https://www.youtube.com/watch?v=cyY0nHXvzGc

swl1956

Keep in mind ADT affects men differently. Some have very little side effects and others struggle with it. Dr. Scholz points out that you can always discontinue it if it's too much of a burden.

Wheel

i am 100 percent behind the single port robotic surgery. Also the surgery procedure position that spares the Puboprostatic ligament normally cut in most procedures. With it not being cut this keeps your penis length and in most cases eliminate’s incontinence. I was dry immediately. In addition the nerve sparing, and Retzius sparing keeps ED to a minimum not certainly guaranteed but in my case worked. I just need to take Viagra and good to go. Went home same day of procedure. 3 days after catheter out traveled by car for four hours, on plane a month later internationally. I had procedure last year, am 72. Still have Radiation available in future. No months long Radiation treatments or ADT for long time. I believe certainly Radiation Oncologist’s believe in their work as Surgical Oncologist’s also do so just make sure you research both and get the best. I am glad it was over in four weeks recovery and feel like my gallbladder got removed.

Steve1961

here is my opinion ADT is the third option is the last option. It’s a horrible option. It literally destroys a man. I don’t care what anybody says look up the gold standard for prostrate cancer if it is localized and you expect to live 10 years or more Gold standard is surgery then you have radiation as a backup and then you also have the dreaded ADT as last choice Also, you need to make sure cancer is not Cribbiform I was diagnosed at age 56. My PSA was about the same. It was 3+4 and I was scared to death of surgery. The decifor testing said that I had cribbiform So I chose the radiation route which was a huge mistake huge for one it tore me up And for two it did not work five years later my PSA went down to 0.8 and started climbing only to find out that the for cancer was still inside me. It did not take to the radiation. Let nobody tell you any Different cribbiform is radiation resistant so my friend choice is yours. You’re only 66 to me the surgery was a piece of cake. I wish I would’ve the first time around even salvage surgery wasn’t that bad except I do leak a little bit But now I can’t have radiation again so if it happens to come back, all I can do is a dreaded hormone a simple process step one surgery. It’s done it’s gone. It’s out of your body if your psa is not undetectable you could do radiation to kill the rest of . Keep the radiation as a backup and the ADT as a third backup but if you’re gonna go that route the radiator you must and you must make sure it is not crib form that’s just my opinion. Good luck to you.