Well, after eight years(diagnosed at 52, now 60) in Active Surveillance this new Pirad 4 lesion got me. It was prompted by my PSA rising from 8 last June to 13.7 in December and 10 in April. Only one core but it’s 80% of the core and 3+4(10% 4). My doctor is one of the best surgeons around but he has also been doing Focal Therapy for 15 years He used to do the heat method but now does the freezing. I’m having him refer me to a RO for a consult also. I really don’t want to do the surgery. The Focal appeals because I would hope for fewer complications but realize I’ll probably be back in this same dilemma in a few years. I’ve also read of many good SBRT out comes. I would love to hear everyone’s logic on my options because I just got the news and I am not thinking clearly. Thanks!
Path Report
A. Prostate, right posterior, biopsy
- Benign prostatic tissue
B. Prostate, right mid, biopsy
- Benign prostatic tissue
C. Prostate, right anterior, biopsy
- Benign prostatic tissue
D. Prostate, ROI midline, biopsy
- Benign prostatic tissue
E. Prostate, ROI midline 2, biopsy
- Prostatic adenocarcinoma, Gleason grade 3+4=7 (10% pattern 4), grade group 2, in one of one core, involving 80% of total core tissue
F. Prostate, left posterior, biopsy
- Benign prostatic tissue
G. Prostate, left mid, biopsy
- Benign prostatic tissue
H. Prostate, left anterior, biopsy
- Benign prostatic tissue
Hello again…. Your concerns about focal therapy are valid but some think it is worth it to kick the can down the road and maybe not need future treatment.
I think I would get a second opinion on the pathology to confirm the findings since you are basing a lot on one number. Johns Hopkins offers those services as well as others and I did not find it difficult to obtain.
You might want to consider HD Brachytherapy, even faster method than SBRT and can be done in one procedure. The internal radiation is controlled better so probably less side effects and would be easy to travel somewhere to find a top place for the procedure.
You have plenty of time to figure this out so check out everything and make the choice that makes sense to you, simple?
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) Tert Gr5, pT3a pN0, Grp 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Grp 5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 sessions
PSA<0.10: 2019, 2020, 2021, 2022, 2023, 2024, 2025
I think I would get a second opinion on the pathology to confirm the findings since you are basing a lot on one number. Johns Hopkins offers those services as well as others and I did not find it difficult to obtain.
You might want to consider HD Brachytherapy, even faster method than SBRT and can be done in one procedure. The internal radiation is controlled better so probably less side effects and would be easy to travel somewhere to find a top place for the procedure.
You have plenty of time to figure this out so check out everything and make the choice that makes sense to you, simple?
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) Tert Gr5, pT3a pN0, Grp 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Grp 5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 sessions
PSA<0.10: 2019, 2020, 2021, 2022, 2023, 2024, 2025
Yes, hello again Mumbo! I sure appreciate all the helpful advice you’ve given over the years. I was really hoping I could avoid making a treatment decision for quite a few more years. My urologist did mention AS is still open to me but he doesn’t recommend it because it was just 17 months ago when my last MRI and biopsy didn’t even show this new lesion. Coming with a spike in the PSA from 8 to 13.7 and one core that was 80%(10% +4) has me more than a little nervous about continuing in AS. One thing that worries me about going the RALP route is that I leave alone, except for my needy German Shepherd. Can a person even consider RALP with nobody to care for him? One other thing that worries me is that I definitely am noticing weakened urine flow. I worry that only gets worse with a radiation solution.
4/18 PSA 6.2
5/18 DRE Nodule on left side
6/18 Biopsy
2 of 12 positive Gleason 6
Left Apex 15%
Left Medial Apex 30%
6/18 Start AS
7/18 OncoType DX GPS Score 12
9/18 PSA 3.2
1/19 PSA 4.5
4/19 PSA 2.5
4/18 PSA 6.2
5/18 DRE Nodule on left side
6/18 Biopsy
2 of 12 positive Gleason 6
Left Apex 15%
Left Medial Apex 30%
6/18 Start AS
7/18 OncoType DX GPS Score 12
9/18 PSA 3.2
1/19 PSA 4.5
4/19 PSA 2.5
Focal cryoablation can be a good treatment with the recognition that cure rates are generally lower than the other options you're considering. It is also likely to have fewer side effects. Usually you can have future repeat cyro treatments if and when needed.
I had salvage cryoablation in December, 2024 and so far so good. No complications or side effects. Recent imaging and biopsy were negative. In my case my initial primary treatment was radiation using Protons and I had a recurrence 10 years later so my options for treating this recurrence were limited. After primary radiation it is generally not recommended to have radiation again although salvage focal brachytherapy was an option. Surgery was really not feasible after radiation. I am close to Duke Cancer Center and one of the best cryoablation surgeons in the country.
I suggest you research the difficulty with cryoablation for your cancer location. Being near the urethra can be problematic.
Age 69 DX 06/14
proton at UFPTI 11/14-01/15
01/24 BCF
02/24 PSMA no spread
05/24 mpmri pirads 5
10/24 PSMA no spread
10/24 biopsy 4+3 w/PNI
12/24 focal cyro
PSA:
07/15 2.5
01/16 1.3
07/16 2.5
01/17 .7
01/18 1.4
04/18 .7
07/18 .8
01/19 .8
01/20 .9
02/21 1.0
02/22 1.2
01/24 3.3
02/24 3.6
10/24 5.6
03/25 0.31
10/25 0.34
I had salvage cryoablation in December, 2024 and so far so good. No complications or side effects. Recent imaging and biopsy were negative. In my case my initial primary treatment was radiation using Protons and I had a recurrence 10 years later so my options for treating this recurrence were limited. After primary radiation it is generally not recommended to have radiation again although salvage focal brachytherapy was an option. Surgery was really not feasible after radiation. I am close to Duke Cancer Center and one of the best cryoablation surgeons in the country.
I suggest you research the difficulty with cryoablation for your cancer location. Being near the urethra can be problematic.
Age 69 DX 06/14
proton at UFPTI 11/14-01/15
01/24 BCF
02/24 PSMA no spread
05/24 mpmri pirads 5
10/24 PSMA no spread
10/24 biopsy 4+3 w/PNI
12/24 focal cyro
PSA:
07/15 2.5
01/16 1.3
07/16 2.5
01/17 .7
01/18 1.4
04/18 .7
07/18 .8
01/19 .8
01/20 .9
02/21 1.0
02/22 1.2
01/24 3.3
02/24 3.6
10/24 5.6
03/25 0.31
10/25 0.34
convertible - A second opinion on the pathology will go along way towards helping make the AS decision. It could be better, worse, of the same which is good info to have. Sometimes the opinion will be 3+3 or not cancer <3 which changes the decision tree. It can also be 4+3 which means no treatment question at all.
I found RALP a lot to handle for a few days after release so having a spouse was very beneficial. Hard to imagine doing it by yourself but PCa does not always pick on the married men. I would have probably passed out in my recliner due to lack of food and water if I had to do myself as getting up was such a hassle at first.
One of the instructions is to not drive home nor when taking pain drugs which is not much of a problem because you don't feel like driving but you can always find a way home. The catheter is a learning experience when changing clothes, etc so a helper is invaluable.
The urinary issue would be solved with surgery but the problem reverses and will you will be worried that you cannot control peeing after surgery. There are meds you can take to shrink prostate before RT so these are questions for RO.
I found RALP a lot to handle for a few days after release so having a spouse was very beneficial. Hard to imagine doing it by yourself but PCa does not always pick on the married men. I would have probably passed out in my recliner due to lack of food and water if I had to do myself as getting up was such a hassle at first.
One of the instructions is to not drive home nor when taking pain drugs which is not much of a problem because you don't feel like driving but you can always find a way home. The catheter is a learning experience when changing clothes, etc so a helper is invaluable.
The urinary issue would be solved with surgery but the problem reverses and will you will be worried that you cannot control peeing after surgery. There are meds you can take to shrink prostate before RT so these are questions for RO.
Choosing a treatment path can be the most challenging aspect of this disease. For most guys with an early diagnosis cure rates are very high for all of the treatments. For myself I found SBRT to be effective convenient and having very low side effect risks. I’d be glad to answer any questions you might have about my experience. Best wishes…Terry
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
Thank you for the response Terry………by the way is that a wine cellar and do you give samples? Sorry, I got distracted for a minute. Originally, I was most interested in my Urologist telling me he does Cryoablation but as I study up I’m concerned by the percentage of “permanent ED” I’m seeing. That firmly puts SBRT has my first choice. As I’ve mentioned earlier, living alone has me very concerned about undergoing RALP. I’ve also very seriously considered Mumbo’s advice about a second opinion on the biopsy but I think I’m going to save my $400 because of the huge jump in my PSA and the fact that my Pirad 4 lesion appeared within 17 months from my last MRI. Even if the second opinion says there’s less grade 4 I have to wonder whats just next to where the needle went in and is that area why my PSA spiked to 13.7. Regardless, of what the actual biopsy results are that PSA puts me firmly into the Stage 2 category so I think after eight years it’s unfortunately time to act. Especially, since my current 3+4 gives me a “favorable” intermediate risk(I know, a second opinion could officially put me back to low risk).
Anyway, I guess what I would really like to know is what been the worst part of your SBRT treatment. Is there something you didn’t expect or weren’t prepared for that happened during treatment or in the years past. I’m 60 and really hoping to continue dating and enjoying sex but I really don’t want to wear a diaper or end up with bowel troubles. My grandfather had PCa but my dad never went to the doctor so I don’t know what was wrong with him except when he was 78 he went in for pain they thought was his appendix and turned out to be colon cancer that killed him in 11 months.
Anyway, I guess what I would really like to know is what been the worst part of your SBRT treatment. Is there something you didn’t expect or weren’t prepared for that happened during treatment or in the years past. I’m 60 and really hoping to continue dating and enjoying sex but I really don’t want to wear a diaper or end up with bowel troubles. My grandfather had PCa but my dad never went to the doctor so I don’t know what was wrong with him except when he was 78 he went in for pain they thought was his appendix and turned out to be colon cancer that killed him in 11 months.
68…I’m an amateur winemaker. Enjoying mostly Finger Lakes Rieslings these days. Be glad to share a glass of wine with you. It was through this site that I heard about SBRT. A lot has changed in the ten years since my diagnosis. Back then even as a low volume G-6 my urologist was ready to schedule surgery. I’m so grateful for the advice found on this forum. At diagnosis I was in the middle of needing arthroscopy on both knees and shoulders and the fear of having a sepsis infection from additional biopsies placed me in a high risk of losing those new joints so I chose aggressive treatment. My hope was to find an effective PCa treatment that would not risk urinary or sexual function that had me quickly rule out surgery. I know a lot of guys who have had surgery have done well; but, the data didn’t support the risk.
With new grandchildren to hold I ruled out seeds. Traditional beam radiation (low dose) required 45 treatments with an hour plus of travel each way. SBRT was patterned off of high dose brachytherapy; but, delivered as a beam. I was treated with the typical five fractions. Since these were high fraction doses I wanted to be certain that I could find a treatment team experienced in this process. Cleveland Clinic was only 2.5 hours away and was an excellent fit.
The process turned out to be easy and quick. We used the trips as an adventure to find new places to enjoy lunch on treatment days so travel was not an issue. I was able to keep up with my normal YMCA cycling classes even on radiation days. Our CCI team advised us to do everything we normally do (including sex). We followed Dr.’s orders. Following the third fraction I did notice some soreness in my perineal area when cycling. Also, some mild burning during urination and ejaculation. I took an over the counter medication called AZO and it helped. The mild burning lasted less than two weeks. I’m only a data point of one; but, based on what my team at CCI and the guys on this forum have shared my results are pretty typical for SBRT. Prostate removal is a very big deal even for younger guys. My issues were very minor. Married to the same lovely girl for 57 years and I consider my self almost a virgin since she’s the only person I’ve had sex with and it’s still very good. No matter what your treatment choice is be sure to do your homework and find the very best team you can find. I believe the best do make a difference. Best wishes…Terry
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
With new grandchildren to hold I ruled out seeds. Traditional beam radiation (low dose) required 45 treatments with an hour plus of travel each way. SBRT was patterned off of high dose brachytherapy; but, delivered as a beam. I was treated with the typical five fractions. Since these were high fraction doses I wanted to be certain that I could find a treatment team experienced in this process. Cleveland Clinic was only 2.5 hours away and was an excellent fit.
The process turned out to be easy and quick. We used the trips as an adventure to find new places to enjoy lunch on treatment days so travel was not an issue. I was able to keep up with my normal YMCA cycling classes even on radiation days. Our CCI team advised us to do everything we normally do (including sex). We followed Dr.’s orders. Following the third fraction I did notice some soreness in my perineal area when cycling. Also, some mild burning during urination and ejaculation. I took an over the counter medication called AZO and it helped. The mild burning lasted less than two weeks. I’m only a data point of one; but, based on what my team at CCI and the guys on this forum have shared my results are pretty typical for SBRT. Prostate removal is a very big deal even for younger guys. My issues were very minor. Married to the same lovely girl for 57 years and I consider my self almost a virgin since she’s the only person I’ve had sex with and it’s still very good. No matter what your treatment choice is be sure to do your homework and find the very best team you can find. I believe the best do make a difference. Best wishes…Terry
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
Terry, your story really connects with me. My treatment center is Barnes Jewish and it’s a 2 1/2 hr drive for me by way of the interstate. Because of my MRI showing a Pirad 4 I expected bad news from the biopsy but I thought “What the heck” and took my driver the backseat roads way to the hospital the day before. We stopped at historic sites, an interesting small town and ate at a little place that had great outdoor ambience. Somehow it was actually a fun time. I can really see myself doing that every treatment if I choose SBRT. I especially love how your treatment team wanted you doing all the things you did and I really love the fact that you have a great marriage. Thanks.
“I love it when a plan comes together”
However, I am always wary of medical procedures and proceed cautiously. Too many odd experiences where the doctor said afterwards “that is a common reaction, nothing to worry about, it will go away in time” as I am applying cream to a nasty rash or running to a bathroom at Home Depot.
Good luck!
However, I am always wary of medical procedures and proceed cautiously. Too many odd experiences where the doctor said afterwards “that is a common reaction, nothing to worry about, it will go away in time” as I am applying cream to a nasty rash or running to a bathroom at Home Depot.
Good luck!
The Siteman Cancer Center is nationally recognized as one of the best in the world. A great choice. Best wishes and keep us posted as we learn from one another’s experiences…Terry
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
Well, this news hits hard. Got my Decipher score back and it’s .85. So much for my plan for just SBRT. I’d seen the RO and he told me he viewed me as Intermediate Risk unfavorable and said you could do radiation only if I did ADT. Since I objected he said if the Decipher came back low risk he could rule out hormones. That just went out the window. Somehow I keep getting pushed into the one treatment I said I would never do……RALP.
I am not sure why a *temporary* period of adt has you worried.
Do not let tbe fear of adt force you into something you really do not want.
Its not forever. It will have a beginning and end date. Its very manageable (keep moving, exercise etc...), and the great part is you probably can start it pretty quickly as they set you up for the radiation treatments dramatically reducing chances of spread.
Age 52 7/2019, PSA 5.5
Biopsy 4/12 positive, G8
RALP 10/2019 G9 (4+5). SVI- EPE+ Clean margins. 9 nodes clean.
3/20 IMRT 68 Gy (during Covid) 1/20--7/20 Lupron
PSA: 11/19: 0.10, 1/20:0.11, 8/20: <0.02, 1/21: <0.02, 4/21: 0.07, 7/21 0.18, 9/21 0.3, 11/21 0.48, 2/22 0.56, 5/22 0.74, 8/22 1.01, 11/22 1.36, 2/23 1.87
8/22 and 2/23 Psma Pet: met(s) in lung
4/23 lupron, xtandi psa<0.04
Do not let tbe fear of adt force you into something you really do not want.
Its not forever. It will have a beginning and end date. Its very manageable (keep moving, exercise etc...), and the great part is you probably can start it pretty quickly as they set you up for the radiation treatments dramatically reducing chances of spread.
Age 52 7/2019, PSA 5.5
Biopsy 4/12 positive, G8
RALP 10/2019 G9 (4+5). SVI- EPE+ Clean margins. 9 nodes clean.
3/20 IMRT 68 Gy (during Covid) 1/20--7/20 Lupron
PSA: 11/19: 0.10, 1/20:0.11, 8/20: <0.02, 1/21: <0.02, 4/21: 0.07, 7/21 0.18, 9/21 0.3, 11/21 0.48, 2/22 0.56, 5/22 0.74, 8/22 1.01, 11/22 1.36, 2/23 1.87
8/22 and 2/23 Psma Pet: met(s) in lung
4/23 lupron, xtandi psa<0.04
My next question would be how long on ADT? The trend is towards shorter periods based on recent studies so maybe 12 mos might work for your situation?
I tend to agree that ADT may suck but all treatments suck for various reasons and weighing hormone reduction effects vs other side effects is difficult at best thus should not wreck an otherwise solid plan.
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) Tert Gr5, pT3a pN0, Grp 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Grp 5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 sessions
PSA<0.10: 2019, 2020, 2021, 2022, 2023, 2024, 2025
I tend to agree that ADT may suck but all treatments suck for various reasons and weighing hormone reduction effects vs other side effects is difficult at best thus should not wreck an otherwise solid plan.
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) Tert Gr5, pT3a pN0, Grp 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Grp 5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 sessions
PSA<0.10: 2019, 2020, 2021, 2022, 2023, 2024, 2025
My RO said 6 months of ADT. I asked him about Orgovyx and he said I might have difficulty getting my insurance to cover it since it’s fairly new to the market. He said expect it to be Lupron but he would try to get it for me if i choose SBRT. I voiced my concern that my blood pressure, my glucose levels, and my cholesterol are all verging on needing treatment and I’m worried even six months of ADT might cause me lifelong problems with those conditions. Otherwise, I’m a fairly active, almost in shape 60 year old.
4/18 PSA 6.2
5/18 DRE Nodule on left side
6/18 Biopsy
2 of 12 positive Gleason 6
Left Apex 15%
Left Medial Apex 30%
6/18 Start AS
7/18 OncoType DX GPS Score 12
9/18 PSA 3.2
1/19 PSA 4.5
4/19 PSA 2.5
4/18 PSA 6.2
5/18 DRE Nodule on left side
6/18 Biopsy
2 of 12 positive Gleason 6
Left Apex 15%
Left Medial Apex 30%
6/18 Start AS
7/18 OncoType DX GPS Score 12
9/18 PSA 3.2
1/19 PSA 4.5
4/19 PSA 2.5
Six months sounds pretty tolerable, the Orgovyx cost is not so good. Insurance objection will be why you need this more expensive drug. Do you have any documented issues that could support using the better drug that RO could rely on?
You may want to contact Pfizer patient assistance for their thoughts. My wife is on a much more expensive cancer drug and was able to get drug directly from Pfizer for a few years at no cost before having to use a grant program. Medicare has an out of pocket drug limit now of $2,100 so she just pays that in January and is done for the year for all drugs, something to look forward to.
My guess is that six months is not long enough for permanent damage from ADT drugs but that is just a guess, nothing more. The odd thing with ADT is some are affected more than others and there seems to be no logic to it. I have known a couple of men that did longer durations and did not complain about it much, just glad when they were done.
You may want to contact Pfizer patient assistance for their thoughts. My wife is on a much more expensive cancer drug and was able to get drug directly from Pfizer for a few years at no cost before having to use a grant program. Medicare has an out of pocket drug limit now of $2,100 so she just pays that in January and is done for the year for all drugs, something to look forward to.
My guess is that six months is not long enough for permanent damage from ADT drugs but that is just a guess, nothing more. The odd thing with ADT is some are affected more than others and there seems to be no logic to it. I have known a couple of men that did longer durations and did not complain about it much, just glad when they were done.
Hi Convertible:
I think your RO is giving you great advice. SBRT + 6 months of ADT is a pretty standard treatment for a case like yours. The short ADT duration should be tolerable and a return to your normal activities (including sexual) should be forthcoming. Of course the Decipher score is troubling but shouldn't push you towards surgery -- in fact just the opposite in my opinion.
Good luck. Hope all goes well.
Jim
Forum Moderator-Prostate Cancer. Age 62 (80 now). G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-15 yr: <1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1
I think your RO is giving you great advice. SBRT + 6 months of ADT is a pretty standard treatment for a case like yours. The short ADT duration should be tolerable and a return to your normal activities (including sexual) should be forthcoming. Of course the Decipher score is troubling but shouldn't push you towards surgery -- in fact just the opposite in my opinion.
Good luck. Hope all goes well.
Jim
Forum Moderator-Prostate Cancer. Age 62 (80 now). G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-15 yr: <1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1
6 months will go very quickly. You will feel tired but if you keep your exercise routine going, you will be ok.
While on adt, if you are feeling tired, ask yourself "Self, did i do anything today to warrant feeling tired?" If the answer is "No", then avoid the couch and move. Go to the store. Park farther than normal. Go to the gym, even if just 15 minutes. Just do not lie down. 6 months will go quickly.
After the 6 months, when it wears off, you will appreciate the new found energy, and its going to be epic!
Age 52 7/2019, PSA 5.5
Biopsy 4/12 positive, G8
RALP 10/2019 G9 (4+5). SVI- EPE+ Clean margins. 9 nodes clean.
3/20 IMRT 68 Gy (during Covid) 1/20--7/20 Lupron
PSA: 11/19: 0.10, 1/20:0.11, 8/20: <0.02, 1/21: <0.02, 4/21: 0.07, 7/21 0.18, 9/21 0.3, 11/21 0.48, 2/22 0.56, 5/22 0.74, 8/22 1.01, 11/22 1.36, 2/23 1.87
8/22 and 2/23 Psma Pet: met(s) in lung
4/23 lupron, xtandi psa<0.04
While on adt, if you are feeling tired, ask yourself "Self, did i do anything today to warrant feeling tired?" If the answer is "No", then avoid the couch and move. Go to the store. Park farther than normal. Go to the gym, even if just 15 minutes. Just do not lie down. 6 months will go quickly.
After the 6 months, when it wears off, you will appreciate the new found energy, and its going to be epic!
Age 52 7/2019, PSA 5.5
Biopsy 4/12 positive, G8
RALP 10/2019 G9 (4+5). SVI- EPE+ Clean margins. 9 nodes clean.
3/20 IMRT 68 Gy (during Covid) 1/20--7/20 Lupron
PSA: 11/19: 0.10, 1/20:0.11, 8/20: <0.02, 1/21: <0.02, 4/21: 0.07, 7/21 0.18, 9/21 0.3, 11/21 0.48, 2/22 0.56, 5/22 0.74, 8/22 1.01, 11/22 1.36, 2/23 1.87
8/22 and 2/23 Psma Pet: met(s) in lung
4/23 lupron, xtandi psa<0.04
68...Although I have no personal experience with ADT meds two of my personal friends do. Both sing the praises of exercise to minimize the unpleasant side effects. These drugs typically stop the cancer from progressing and weaken the existing cancer cells significantly making any future radiation even more effective. Keep up or increase your exercise routine. The staff at CCI say they see much better results when patients they treat remain physically active. My personal results suggest the same. Best wishes...Terry
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
Rising PSA
11/12 1.98
11/13 1.95
9/15 3.28
10/16 5.94
1/17 3.0 (different lab)
TRUS 1/17
Bx: 3 of 12 cores adenocarcinoma Gleason 6 (3+3)
all on left side
DOB 7/21/47 good health.
Age 69 @ Dx
SBRT by Dr. Tendulcar @
Cleveland Clinic 6/23/17
Reduced ejaculate is only side effect. Everything works
PSA’s post SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4, 0.4, 0.2, 0.13
I really appreciate all the timely responses. My immediate knee jerk reaction was to call the surgeon and schedule RALP. The fact that so far every response indicates six months isn’t so bad now has me pausing. I know I need to make a decision soon and while I knew this would be difficult it’s even tougher than I anticipated. Thanks so much for responding.
4/18 PSA 6.2
5/18 DRE Nodule on left side
6/18 Biopsy
2 of 12 positive Gleason 6
Left Apex 15%
Left Medial Apex 30%
6/18 Start AS
7/18 OncoType DX GPS Score 12
9/18 PSA 3.2
1/19 PSA 4.5
4/19 PSA 2.5
4/18 PSA 6.2
5/18 DRE Nodule on left side
6/18 Biopsy
2 of 12 positive Gleason 6
Left Apex 15%
Left Medial Apex 30%
6/18 Start AS
7/18 OncoType DX GPS Score 12
9/18 PSA 3.2
1/19 PSA 4.5
4/19 PSA 2.5