New PC Diagnosis - Intermediate Unfavorable

tikhon33
tikhon33 Member Posts: 7 Member
edited October 2023 in Prostate Cancer #1

I went to a doctor recently for a check-up and was notified that I had a high PSA of 5.0 (I had no symptoms of prostate issues) and he recommended that I have a free PSA test done which also came back as 0.26 which was not great.

MRI:

I had an MRI done and that showed a lesion on my prostate which led to the dreaded biopsy

MRI results showed a left peripheral lesion of 1.2CM - PI-RADS 4

Biopsy results were a Gleason Score of 4+3=7.

After meeting with the Radiology Oncologist to discuss, he ordered a PET Scan and a Decipher test.

Yesterday I had an appointment with the Radiology Oncologist to discuss the results of those tests and he said there was no sign of metastases from the PET Scan which was good, however, the results of the Decipher test and that came back .98-high risk...

Not so good.

Since it's probably important info, at the same time all of this started, I was downsized from my job of 17 years as an IT professional which meant I was losing my health insurance, so I am now on my former company's COBRA plan and am looking for another job while dealing with this unfortunate turn of events.

It looks like the options are:

1. Prostate removal

2. Radiation + Hormone Therapy

Leaning more towards #2 but have heard that the Hormone Therapy is kind of awful.

Thanks for any experience or advice.

God Bless

Comments

  • Clevelandguy
    Clevelandguy Member Posts: 1,180 Member
    edited October 2023 #2

    Hi,

    Its really your choice of ether radiation or surgery with the consults of your loved ones and doctors. If I were you I would be seeing a Urologist and Oncologist to present you with treatment options. Making sure the cancer is still inside of the Prostate can also be a big help in decisions. In my humble non medical opinion great doctors +great facilities = great results. Be sure you study the side effects and determine how they will effect you. ADT can have some nasty side effects which varies from person to person. Radiation like Cyberknife and Proton are very good and usually have lessor side effects. I guess if you wanted to you could start the ADT and if the side effects are really bad just stop it. The ADT will not kill your cancer but weaken it. Time for you to study and decide. I have included a link to get you started. I had surgery back in 2014 and don’t regret it. Had ED for a while and still occasionally drip a drop during sneezing or heavy lifting. Good luck………

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

    Dave 3+4

  • tikhon33
    tikhon33 Member Posts: 7 Member
    #3
    https://csn.cancer.org/discussion/comment/1710087#Comment_1710087

    Thanks Dave.

    In your post you wrote:

    "I guess if you wanted to you could start the ADT and if the side effects are really bad just stop it. The ADT will not kill your cancer but weaken it. "

    I'm not too crazy about the hormone therapy aspect of this and was wondering if just pursuing radiation is an option or not.

    Thanks again for your response.

  • Clevelandguy
    Clevelandguy Member Posts: 1,180 Member
    #4

    Hi,

    My thought exactly, if my cancer returns ADT will be questionable in my treatment plan due to the side effects. Radiation side effects might be bad enough but then tack on x number of months ADT? Hopefully some newer ADT drugs will emerge with less side effects.🙏

    Dave 3+4

  • RickLeon
    RickLeon Member Posts: 10 Member
    #5

    Hi,

    I'm also 4+3. My biopsy was April 2022. I decided on a Radical Prostectomy in Aug 2022. Post surgery my Nov 2022 ultrasensitive PSA was <0.01 (non detectable), but Feb 2023 PSA was 0.04, May 2023 was 0.08, Aug 2023 was 0.13. Still low but rising quickly. I retest Nov 10th. I've decided on Salvage radiation in the prostate bed and pelvic lymph nodes starting January 2024. I'll get 38 treatments lasting until the end of February. I also didn't want ADT, BUT my decipher test just came back at 0.75, which puts me in the high risk grade. Because of the high risk, I start 6 month ADT on Nov 15th.

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #6

    This is your chance to slay the beast and I would throw all the reasonable tools at it. This would include some form of ADT. Not just my opinion, but that of the American Urological Association as well (ASTRO Guideline 2022):

    In patients with unfavorable intermediate-risk prostate cancer electing radiation therapy, clinicians should offer the addition of short-course (four to six months) ADT with radiation therapy. (Strong Recommendation; Evidence Level: Grade A)

    Almost all men who undergo a short course of ADT will get back to normal after the testosterone recovers. You can ask for Orgovyx (pills). It works a bit faster than leuprolide and wears off faster as well.

    Although by no means proof, I had 18 months of ADT (along with a lot of radiation) and lived to tell the tale as of now.

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