Intermediate-Risk: Do You Need Hormone Therapy With Radiation? |
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- เผยแพร่เมื่อ 26 มี.ค. 2024
- Dose-Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Deprivation for Intermediate-Risk Prostate Cancer: Results of a Phase III Multi-Institutional Trial: pubmed.ncbi.nlm.nih.gov/37104...
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0:39 Should hormone therapy always accompany radiation therapy?
6:24 Should age play a role in deciding whether or not to get short-term hormone therapy?
8:01 At what point does short-term hormone therapy become with the side effects?
9:55 Is it ever appropriate to delay hormone therapy after radiation?
11:32 Alex's conclusions
13:23 If you need more help
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At age 78, I have shocked my doctors by declining hormone therapy. Good news. I am still active and work physically most days of the week. This is good news to me as well.
My two cents: I am 70 yr old male, had Gleason 4+3, chose radiation (SBRT), and declined ADT. This is a very reassuring study!
70 also. Waiting for my biopsy results.
70 as well. One 3+4, others 3+3, psa 7.12. I chose radiation only. My RO aggreed stating we could start HT down the road if needed.
@@davewilton3101 Best wishes for a successful treatment journey. A bit surprised that even with 3+4, you chose treatment as opposed to AS...To the larger question, I have to believe that many urologists and oncologists are marketed to do by pharmaceutical interests to promote ADT.
Good luck for a successful journey, whatever road you take!@@keithcolegrove2924 G
Any side effects from the sbrt?? Ed etc
I was diagnosed with a PSA of 37.2 and a PI RAD 5 tumor with 3 +4 Gleason Score early April last year at age 65. I started 6 months of hormone therapy with Lupron Depot on May 5th when they installed the Space Oar, and 28 sessions of external beam radiation to my prostate, seminal vesicles, and pelvic lymph nodes on May 22th. Treatment was successful. I found the hormone therapy to be wicked. Especially the hot flashes, and muscle and joint issues. But everything has gotten back to normal. The hot flashes subsided only in the last month, so the side effects of the 6 month injection lasted 11 months. I did 5 miles or greater of daily walking during my entire treatment and post treatment period.
Although I appreciate and applaud your aerobic exercise efforts the real key to overcoming side effects of ADT is resistance training.
Had radiation and hormone therapy. Would never do hormone again. Side effects devastating
What were some of the effects? I’m thinking about getting it.
@@troyelam8978 Hot flashes day and night weight gain and joint pain!
The most terrible sweats all times of the day and night. Change you cloths three time a night. Even end up with enlarged breast Basically how men want a sex change Shrinks your penis and tiny balls! Never do it as they cannot say it extends your life anyway. 😢y@@troyelam8978
@@troyelam8978hot flashes, fatigue, some joint pain
I had PSA 13.5, Gleason 4 +3 7 in two cores, 3 + 3 6 in three cores all left side of the prostate. My Urologist and Oncologist suggested I receive 23 EBRT and LDR Brachytherapy with no ADT. I was very, very happy I didn't have to go through ADT, im 56 years old, 5 grandchildren, ride motorcycles, snowmobiles, love to walk and hike National parks with my wife and quality of life was my #1 goal with my treatment. So far so good, PSA after 8 months down to 2.5. Very few issues, just some urinary urgency at night. I had a friend who chose Prostate removal, he died 4 days after surgery from a blood clot. Im still not over this loss. Thanks, PCRI for all your help and advice and steering me toward radiation treatments!
Thats shocking to hear about your friend and tragic and scary. I was offered surgery but don't like the high % of possible side effects, i have 3 cores 3+4, highest core 20% 4, and 1 core 3+3 left and 3+3 right, psa 8.8. Iam looking into getting nanoknife or hifu, or if i can't get them then seed brachytherapy, but no ADT i will take my chances without that. Sorry to hear about your friend, so sad.
@@hyway62 Thank you for your thoughts. My friend was a fellow Veteran, 58 years old and healthy otherwise. I think his urologists talked him into surgery, and he was scared to question a doctor and now he is gone because of it. Just had his first grandchild. What a tragic loss. I wish everyone could see Dr. Scholz and PCRI. Good luck with your treatments. Do what's right for you and be satisfied with your choice and just enjoy every day!! Life is a gift.
Did your friend get robotic key hole surgery, did u get LDR seed brachytherapy and u have only urgency as a side effect?
@@hyway62 My friend got the robot assist surgery. I got LDR brachytherapy and just had some loose stools after the procedure. I’m up once a night now to go to the bathroom, and during the day go quite frequently.
I had thought that it was either/or with Brachytherapy and some form of external beam radiation. Interesting that you were suggested both.
This is a great video. I am 73 years and I was a 4+3=7. I had a 3-month lupron shot on August 28th, 2023, and declined the second 3-month shot due to side effects. They were not horrendous but they were troublesome. They are now just about gone after 7 months.
I had 15 sessions of IMRT beam therapy followed by one session brachytherapy boost. All went well with essentially no pain. Also, no pain from the biopsy because the doc used plenty of lidocaine.
With this excellent video, I'm glad I declined the second lupron shot.
Do you have any urine retention problems? I am scared of getting that. I have slow urination especially at night time and I wake up at least five times per night! I always have waking up but lately the slow stream and hard starting is troublesome and I worry really worry if the radiation might make me have to self-cather.OMG!
@@ricknowak4582I have no urinary retention problem but I do have some urgency. That was starting before my radiation. I have always had slower urination if I use artificial sweeteners such as aspartame. Talk to your urologist about the problem.
My PSA was 525 a year ago and now .2. I'm on two ADT's (Nubeqa and Orgovyx), and I just finished a Lutetium trial (6 infusions). Result is "significant reduction" in bone mets and no new lesions since April '23. My Oncologist seems determined to keep me on ADT's indefinitely, but I'm not prepared to live with the side effects for a great deal longer. They are, for me, mostly psychological, but also hot flashes. I'm 61.
Gleason was initially very high, 9 (grade 4+5), I was metastatic, but my blood work has been extremely positive in all areas and the Lutetium had little negative impact on me during the period I was getting it.
I'd love to try a hormonal holiday later this year.
As you pointed out, the side effects of the ADT's are not well explained by doctors. They focus mostly on loss of libido (which has not happened), loss of erectile function (minimal loss), and hot flashes. Very little discussion about the psychological toll of ADT's. That impact is the most surprising: super-heightened anxiety mostly, emotions irrationally amplified.
Thanks for more great advice and ongoing videos from you both.
This episode has confirmed by decision. Finally. I am going to get proton radiation with absolutely .... NO hormone treatments.!!!!!!! THANK YOU!!!
Im 58. Diagnosed at 56. 3 coress positive 1 core 3plus4 just 10 percent. I decided after much research and talking to many people to NOT have hormone therapy. I ultimately under weent 45 treatments of EBRT. Been a year since treatment, PSA continues to go down. Minimal side effects. I am very grateful of my choice.
Why didn't you go on active surveillance? You only had one core 3 + 4 = 7 and 10% volume on the four! I would have done nothing! Oh well it just me. What was the volume on the other two cores? That's very important. The volume of the 3 + 4 = 7. On the ....4.
@@ricknowak4582 the other 2 cores were Gleason 6
These videos are so important ! 55 years old PSA was 69. Gleason 4+3 confined with possible ext. 1 HDR brachythearpy, 25 rounds of radiation and ADT orgovyx and zytiga. I'm at 6 months with the adt. 48 months was recommended. I agree that alot of information was missing when I started. It was layed out as a process. Side effects were not discussed on any of these processes. I value these videos because the stress of researching yourself is greatly reduced due to this kind of content. Thank yall for all you do!
Right away they want to give you hormone treatment.Because it's extra money for everybody involved. I just can't get my head wrapped around the idea that they would take testosterone away which is a very helpful thing for your body to have. They take it away and it makes you sick. W t f. I don't believe cancer feeds off Testosterone. That's what they want you to believe. T o sell you hormone treatments 4:20
Thanks so much for this video. My PSA is currently just above the normal range for my age. (5.56 is the highest it's ever been. Is currently 4.3) I have one 8mm lesion in the left central anterior region of my prostate shown on MRI scan. No other lesions are noted in the prostate, lymph glands or pelvic area. Haven't had biopsy yet, but I will get it done. Hoping for a clean slate or a Gleason 6 or a low 7. I'm almost 73 and can still function sexually. I might accept radiation therapy but I don't think I would want hormone therapy unless absolutely dire circumstances prevented other alternatives. I have watched dozens of these videos on different platforms, and this one is by far the best for information, updates and real hope for alternative treatments.
This is great information. I am 75. Four years ago I had radiation and two levels of hormone therapy. Enzalutamide & Zolodex. I did not tolerate the hormone therapy well. In short it was hell! Quality of life was very poor. I am still suffering the effects and I do not want to take anymore. I will accept any risk in the future. Thanks to you!
I'm with you, John. Still on ADT's, but angling to get off. Would rather continue with strict lifestyle changers and the non-stop exercise, etc.
Thanks for putting out this information. I received radiation and ADT (Lupron) previously. My quality of life suffered from ADT. I wish I could go back in time and change my decision. - I am working on improving my quality of life with new personnel. Thanks for your good work.
I can empathize with you. Would like to go back and change my decision on ADT too. It's ruined my life. Best wishes.
Of this comment.I am leaning towards surgery. I would rather put up wearing a diaper then suffering through the hormone treatment side effects. In fact today I wore a diaper around the house to see how it would be. Not bad at all. Now, Nine times might be a lot worse. Cause I pee a whole lot. What........ I need to get a rubber mattress covor to protect all the pay that the diaper does not collect ?! I'm serious.
@@ricknowak4582 the adt has little to do with radiation or removal. It’s about the possibility of microscopic spread having already occurred. ADT is like insurance and makes the tumor more receptive to the radiation. I did 28 rounds of imrt with 6 months adt a year ago with no regrets. I started with pirads 5, Gleason 7 4+3 and psa 9.7. Now psa at 0.2.
@@ricknowak4582Rick you do know that surgery doesn’t exclude you from hormone therapy if you’re a high Gleason score or had spread ……
Thank you so much! I had Gleason 7 (2 out of 12 specimens) treated with Proton Therapy. Highest PSA was 4.1. I refused ADT and my doctor was upset. I am glad I did.
It seems that we both had the same PSA ( 4.1) and Gleason 7 ( 2 out of 12 specimens ) . Mine was 3+3 in one specimen and 4+3 in the other RZTM . May i ask if your was 3+4 or 4+3 ?
My prostate cancer was stage three. i did lupron with radiation. it was a rough ride but I think I did well. The radiation proctitus is no fun but Im using suppository steroids for the inflammation. I still find myself very emotional and I've been off the drug lupron for a year now. i get depression a lot. I do a little of walking . being outdoors and walking feels really good. I get a blood test every three months and I also get a stool test and so far there's no active cancer so that's a good thing. I live my life as best as I can.
THANK YOU !! Timely info I needed.. I have an 8.1 PSA and a 3+3 Gleason.... 58 YO...I will be starting Radiation in a couple of weeks.....Glad I declined hormone therapy after seeing this...Thank you
Best of luck!! I don't know where you are located but go see a sexual health doctor before you start. The doctor has penile therapy that can lessen your symptoms from radiation. I don't know what they are but my husband is starting radiation in a few months. We just went to the doctor today. We should have been there 2 years ago before he had prostate removed.
Don’t do radiation or anything with 3+3. That is not cancer and it never spreads. Watch Dr Sholtz other videos on this.
I have one 3+4=7 at 40%core and five 3+3=6 at 5%. PSA 5.4 and PIRADS 4. I have started 28 radiation treatments without hormone therapy. Was glad to hear my Dr took this right course for me. 54 years old
Did you receive Proton Therapy?
@@dr.mickeyjones5822 No I am currently doing IMRT
just received a Gleason 3+4=7 in 4 cores right side 3+3 in 3 cores left side PSA 5.2 PIRADS 4 havent gone with a treatment plan yet , probably go with radiation seeds , no hormone therapy , also wondering if its worth looking outside of Canada for more effective less evasive treatments ? i know it would be expensive but less side effects might be worth it !! So what kind was the 28 radiation treatments you are recieving ? im 58 yrs old
@@markfitz-george1938brachy done right IS the most effective & least harmful curative therapy. Focal therapy has less side effects but is not more effective .. may buy you time if that's what you're looking for.
Thank you for ALL the information. Not just pieces that fit a biased narrative.
Also, I wonder how many men have died from complications from ADT. Many are not spring chickens afterall. A case of a type of cure potentially worse than the disease it is treating.
I have just started my journey with rising psa.
Again, THANK YOU so very much for all the information you share
And Thank You to all the pioneers finding better ways to diagnose and treat all these issues.
I don’t know about dying from the complications of ADT or hormone therapy, but I thought that in increased the thoughts of and/or likelihood of suicide? Not sure about that, but please comment if you know more on that
@alanaldpal950
Same here.
Rising psa isn't the end of the world, a lot will depend on your mri and possible biopsy, but we all know what your going through, its tough stick with it, there is light at the end of the tunnel
I doubt anyone has died of ADT. Women live their whole lives with low testosterone.
I know one older guy whose testosterone never recovered after Lupron…it’s still low.
I’m on orgovyx and other than lower energy I don’t notice any differences.
I'm 61, i had Gleason 3+4 in one sample all contained and very small. Was lucky to go to Stanford and after many tests only needed 5 sessions of sbrt radiation. Now just dealing with fatigue in the afternoons, but no major side effects. All working normally too :)
Just had my first psa 3 months after first treatment. My psa on first day of treatment was 13.4, doc said it should be roughly half after three months and it went down to 7.6. So all is going well and I feel great
thank you Dr. Scholz and Alex. Based on the information from PRCI I had the MRI done and then the guided biopsy resulting in a 3+4 GS two years ago. The prolaris genetic test indicated active surveillance so that is what i have chosen. The first urologist i went to 4 years ago didn't know about prostate MRIs or the prolaris or other genetic testing. Once he saw the biopsy results he wanted to schedule surgery. Based on that urologist's lack of current prostate advances I changed to UofM and my oncologist is much more informed. My PSA is slowly rising and i have had my 3rd prostate MRI and it showed little to no legion growth. from two years ago. I would only go for the radiation treatment and avoid the ADT based on the scary side effects.
How does genetic testing predict if your lesion is going to grow very slowly or not? Just curious because iam 3+4 in 3 out of 5 cores highest core was 25% 4, and 2 cores 3+3 left and right. Iam thinking of doing Active surveillance on the 3+3's and getting nanoknife or hifu on the 3+4, thanks for your comment its very helpful
I am 61 yo, and had Gleason 7 (4+3) with PSA at 10 and just finished 20 visits for Proton Beam Therapy at Loma Linda in SoCal. I told the proton doctor that I preferred not doing hormone therapy and he was fine with that. I was surprised that he did not try to convince me otherwise. By the way I had a PSMA pet scan that showed the prostate CA was confined to the prostate (and showed I had a developing aortic aneurysm, which I had surgery for before the Proton Tx, but that’s another story). Time will tell if that was the right choice, but when looking at the additional side effects of adding hormone therapy to radiation, I might have opted for surgery after all, which was my first inclination. I ended up not doing it but my proton doctor said having a HDR brachytherapy treatment could have been done in conjunction (shortly after radiation was completed) with the Proton Beam Therapy.
love you guys!
THIS IS THE ONLY VIDEO I HAVE GIVEN A "THUMBS-UP" BY YOUR ORGANIZATION.
At 65 I Had Gleason 4+4 .I Refused Hormone Therapy Had 4 Weeks EBRT Then June 2023 I Had Permanent BRACHY Seed Implants. Last Minth My Oncologist Told Me PSA Is 0.6 And My Cancer Is Gone And Is No Longer Detectable.
I am now age70 I had 8 months Lupron ADT & IMRT radiation 20 doses in 2023 The hormone therapy takes a long time to disappear I was told My PSA a month ago 0.32 was undetectable before with ADT I have a persistent soreness in my right foot When dx April 2023 I was 4+3=7 Stage 2C At the time no metastatic spread was found Thank you for educational videos God bless you in your work to help us PCa persons
Thank you Dr. Scholtz & Alex, as always great discussion and insights 😊
I had prostate cancer treatment 10 years ago. My PSA gradually rose to 2.0. I had radiation and 3 months of adt. I decided I wanted no more adt. Mainly because of long term effects. But short term were troubling as well. I'm 68 years old. I'm fine with the 3 months, but I want no more ADT. Great video. Thanks for posting.
This site is an amazing resource....thanks for all you do
Excellent info. Thanks guys.
Thank you for this information. As an SBRT patient nearing completion of my treatment, this was very informative and helpful.
A very helpful video for me as I consider options. I don’t want to do ADT and this helps me with the decision.
2 1/2 years ago I had 12 cores taken and 8 were positive. All were Gleason 7,2 were 4+3 and 6 were 3+4. At age of 65 I choose radiation and had 42 sessions. I was not going to do 6 months of HDT because of side effects. They talked me into doing it and I think HDT is why I got my ED problems. If I was to do again I think I would have passed on the HDT after seeing this video about the study.. Mine wasn't too bad , had hot flashes and was tired. Could care less about sex. Good luck with everything.
I did a short course of Orgovxy pus radiation with one 4+3 lesion. The side effects were devastating-I was suicidal ant one point- and I still am not myself a year later. I told my urologist I’d never do it again.
This is gold! Great info from dr scholz and alex! And important because as time goes on treatments are changing, so its essential to ask questions and do your homework!
I think It's all about money to the pharmaceutical companies. Especially the company that makes.... l u p r o n. Can you imagine how much money goes to these pharmaceutical companies. I don't even believe that testosterone feeds the cancer. I don't believe it. Why would they take to stostern away from you. When it keeps you healthy. To fight cancer you have to be as healthy as you as you can.
Excellent summary
Just completed my last session of radiation w/o adt . I would encourage deciper test in the mix as well
Great video
After watching this video, I asked my doctor about the hormone treatment that I started a month ago and which he said will last for 12 months, in conjunction with radiation. The side effects of the Orgovyx are unpleasant and do interfere with quality of life somewhat. I start radiation next Tuesday. I asked about stopping the hormone treatment once the radiation has started, and my PSA is at zero. He says that he goes by the guidelines, and that the hormone therapy is indicated for a year. He did add that it was my choice, and that I could stop anything I wanted, something I already knew. However, I am reluctant to go against anything that my oncologist recommends so strongly. BTW, I have had a prostatectomy, but it was not able to get all the cancer and it has metastasized to the left side of my pelvis.
I am in the same boat as you. I had a prostatectomy and it also metastasized to my left pelvis as well. I took one shot of Lupron that lasts for 3 months. I am almost at the 3 month mark and am almost done with radiation treatment. I had 10 radiation sessions on the tumor in the pelvic area and will when done 40 on the prostate bed area. Right now my psa is
I noted your photo, are you receiving treatment with the VA? If not, it is worth considering, at least to obtain other opinions and potentialy additional treatment options and testing.
9:01- From PubMed-
"Androgen-deprivation therapy (ADT) by chemical or surgical castration is invariably followed by the recurrence of castration-resistant prostate cancer (CRPC) within a median of 14-20 months (Sharifi et al. 2005)"
If ADT only leads to CRPC, then why bother with it at all?
Better to go full Keto w/intermittent fasting.
ADT such as Lupron seems almost medieval in its wide-ranging and serious QOL side effects. Surely there must be a more modern approach.
As a retired 77 year old CPA and CFP, the most valuable takeaway is : ......you have to get totally unbiased advice from an experienced professional with no financial stake in the advice. As Mark Twain said: a financial incentive blocks the truth. Pay for independent advice. " Free" financial advice is the most expensive . -------Asking a long time professional Ford dealer, if you should buy a Tesla or BMW, is not bright.
I will not have ADT. 77 yo getting SBRT intermediate 4+3 clear PSMA decipher .51
75 yr old. Original dx aug ‘21 Gl 7 4+3. EBRT caused too much pain and led to bladder cancer. Surgery & chemo took care of it. 4 weeks after chemo my wife died from a large glioblastoma. 4 weeks later I had HDR 9/17/21. 9/17/23 psa > 7 and dx stage 4 11/14/23. 1 6mo lupron shot on dx. I used RSO to go to no evidence of disease by 4/19/24.
This is an awesome video. This is very good to know info. Thanks.
So I was intermediate unfavorable with Gleason 4+3 and finished 28 sessions of proton radiation. I was able to get a voucher for Orgovyx and tolerated it great for the first month, then my insurance denied refills for my 3 additional months. I was scheduled to have ADT 4 months total. Insurance wants me to switch to the monthly Eligard shots for the remaining 3 months. After this info, not sure I need to.
ADT is not to be taken lightly. Hot flash are the least of your concerns. Muscle and bone loss were terrible for me, and dental issues too. Here's one you don't hear much about, disruptive sleep patterns. I would wake up every hour, for no reason. Fatigue in the afternoon was another. I was high risk and they wanted me to do two years of Orgovyx, I ended it after a year. That was enough.
Same for me, one year Lupron. I have all the problem of Muscle and bone loss. Never had dental issue all my life, now having cavities. Extreme fatigue and VERY bad sleep- up every hour.
NHS Oncologist keen to get me on Hormone Therapy and Radiation. I asked him outcomes from having HT and he came up with a rate of 15% better outcome with HT! I’m trying to avoid Radiation with integrative treatments but at 58 really not going to take HT.
It is entirely your choice.
As long as you get full disclosure about ALL the horrific quality of life destroying and life shortening side effects and carefully weigh those against the small hoped for benefits.
Unfortunately, most doctors obfuscate the long term and often permanent partial or full CASTRATION.
Testosterone recovery may take more than five years, and more often, low T is a permanent result of this cruel and barbaric treatment
Testosterone actively helps the body repair the damage caused by radiation. This is why blocking testosterone makes radiation treatment more effective.
Patients with psa below 0.2 at time of radiation had the best outcomes.
I’m on orgovyx and I haven’t had any hot flashes nor noticeable fatigue so long as I eat properly. I’m going to the gym and doing well.
OK I may be an exception but… 🎉I am almost 80 and had 6 months of Lupron and 25 treatments of radiation to prostrate and pelvic area as a precaution there might be microscopic spread. None on scans. I am Gleason 4+3.
I am a gym rat and walk around 5 to 6 miles a day. My T was 700 to start and returned to normal 2 months after ending ADT. Just wanted to let you see that there is another side to this ADT story.
Based on genomic testing, I choose to forgo ADT with my SBRT treatment which conclude in October '23.
PSA dropping!
How does genomic testing predict if u should go on ADT??
@@hyway62 Not a Dr. - but genomic tests like Decipher help decided on a treatment plan, dual modality.. I did both Decipher and Polaris(?) - both showed that I was right on the edge of needing both. I choose to pass on ADT
I see u got SBRT any bad side effects with that, like ed or low or no semen
@@hyway62 I believe seminal fluid is produced by the prostate, my prostate is dead, so very little ejaculate. I had lite ED before, but morning viagra takes care of that..
Great info like always, thank you. I was worried because they took dad off his oral med when his PSA started rising and now he is on Pluvicto. I asked Dr if he should stay on oral med incase some cancer cells still react to it, but he said it didnt work like that. Now dad’s PSA is in the high 200s and I’m hearing through the grapevine that Pluvicto is not meant for prostate cancer that has only spread to bones. Weird because they recommended dad for pluvicto before xofigo. Are there any new oral meds for when casodex, zytiga, and xtandi has stopped working? That’s where dad is now. He is on his 2nd pluvicto treatment now.
Thank you for sharing.
Please reach out to our helpline at PCRI.org/helpline if you need help or further information. We know this is a lot to go through and we just have to say you are amazing.
Does the doctor know about the new PSE blood test that are supposed to be 94% accurate opposed to the PSAs 55% accuracy and does he recommend it?
I so appreciate PCRI and these video. I had an RP in 7/21. Recently I had a sudden recurrence with a doubling rate around 5 or 6 months. Results of my PSMA petscan are two affected pelvic lymph notes.
I am 68 years old. With Gleason 9 and bilateral SV involvement.
I am meeting with my urologist to discuss treatment options. I have no enthusiasm for adding in hormone therapy to what I am sure will be radiation treatment. What do you others think?
Question, did this study include both intermediate favorable and intermediate unfavorable patients?
Good lord. Could I have skipped this 6 months of lupron/darolutamide?
It is indeed interesting that Docs routinely recommend radiation alone for organ-confined 3+4 yet routinely add ADT to organ - confined. Gleason 4+3. It’s almost as if they do believe radiation alone can kill Gleason 3+4 but not 4+3.
Or is the ADT to address escaping micro-metastasis (more likely to occur in 4+3)?
What does this study mean for high risk intermediate? Gleason 3+4, PSMA no spread, but high decipher .9 and intraductal diffusion. Did proton and included lymph. Started Orgovyx Nov, Proton Feb, would like to stop Orgovyx in May at 6 months but Dr recommends another 6 months. I'm confused as to the benefit of hormone therapy after treatment. I'd be interested in knowing what increased risk I incur by stopping at 6 months. I'm 70, would like to get my life back but not at the expense of increased possibility of recurrence.
Not to be a Debbie Downer, but one caution in my analysis is that this trial doesn't have a long enough follow up to make a meaningful conclusion. It is interesting to note that distant metastasis rates were significantly lower with a hazardous ratio of 0.25. I think we need more follow up to really know.
Any news on AOH 1996 ?
y'all need to state your staging. this study (J Clin Oncology, 2023) was T2b and T2b only
I'm one of those poor souls who had ADT. Absolutely horrible side effects that have gotten worse 3 years after treatment.. A little off-topic question that maybe someone can answer. I had 45 radiation session treatments Sept-Oct. 2020. Lupron injections 3/20 thru 3/21. My PSA had been stuck at .01 or less since treatment ended, but had a PSA today and it is .04. Does anyone know if that is a significant jump to be worried about? Seeing my urologists in 2 weeks. Thanks.
I am assuming you still have a prostate? If so, do not worry as a recurrence would be defined by a rise to > 2.1 ng/mL (per the Phoenix defition). It is normal for the PSA to bounce around a bit when you still have a prostate left. A rising trend of two or three levels in a row would be cause for concern. Don't stress over one level.
@@elitetrader5468 Thanks for your response. Yes, still have a prostate. What you said is reassuring. Thanks.
I'm glad you're talking about unnecessary hormone treatments.Doctor schultz. Because for a while there , I thought you were being compromised by the pharmaceutical company. To getting a commission. Take it back. For ... Indorsing their products.
After watching many videos on this channel, I am very impressed, but offer this constructive feedback. There is too much reference to technologies (e.g., PSMA PET scan) that insurance companies will not approve as a diagnostic tool. Second, most men do not have the resources to consult with more than two clinicians. Overall, it's important to discuss tools and approaches that are accessible to all patients, including those with limited means and time. More attention should be given to those patients. Finally, it is clear that this channel represents an overall non-interventionist approach. I prefer that to doctors that are overly prone to intervention or biopsy, but it's important to remember that this channel is just one perspective of many.
😮radiation messed up my bladder
Very sorry to hear that...I am getting ready to start radiation in 2 weeks....Scared of that side effect.. Prayers for you sir
off topic but how about provenge after focal to curtail relapse??plus supplements proven to retard prostate cancer eg lycppene + diet per studies
I had PSA of 4.1 and biopsy report from 12 samples showed one 3+3 and one 4+3 . The bone scan showed no spread . I did have an MRI . PI-RADS 4 , 7X6 mm rounded T2 hypointense lesion in the right posterorectal peripheral zone . Having said all that , I understand that the study shows that for Gleason 7 do not really have to do hormone therapy . By Gleason 7 , i understand 4+3 and or 3+4 . Am i right ?
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off topic but I don't understand that on one side they say.. Gleeson 6 will never metastasize then on the other 50% of patients with Gleeson 6 go on to have treatment within 10 years.. Can gleeson 6 change to Gleeson 7.. Anyone. Please help.
Prostate cancer is a multifocal disease and other areas of the prostate develop other tumors that can be higher grade. Or somebody can have a 3 + 3 that was underread. But pure 3 + 3 tumors do not metastasize nor do they change into other forms.
The study was made on patients with Gleason 7, T2b-C, PSa greater than 10 patients. I assume by Gleason 7 that it is 4+3 and or 3+ 4. What is your understanding and am i right about my assumption?
I am aged 66 . My PSA is 4.1 and biopsy report from 12 samples showed one 3+3 and one 4+3 . The bone scan showed no spread . Am i considered as Intermediate Risk Prostate Cancer ? Should i do Radiation therapy with or without hormone therapy ?
Gleason 4+3 = 7 = Grade Group 3 which technically places you in the Unfavorable Intermediate Risk Group. What I will share with you is I had an initial meeting with my Radiation Oncologist ( on biopsy I had 12 cores done, 1 was 3+3, 1 was 3+4 and 2 were 4+3) As part of my staging work up I have a PSMA pet scheduled in a month and this next part will be of interest to you and others as I had not heard of it before.
He is sending my biopsy slides off to be evaluated by ArteraAI Prostate test ( you can Google search it for all the details). Basically it determines if you are AI biomarker Negative and thus may not require short term androgen therapy vs AI biomarker Positive who may greatly benefit from short term androgen therapy. The AI determines the 34% of individuals that may greatly benefit from short term androgen therapy. My RadOnc told me if my test comes back AI negative then he would not recommend androgen therapy. This test along with the study that Dr. Scholz speaks to in the video can be a part of your shared decision making process with your treatment team, but you might have to prod them or alert them to it, as they may be unaware.
I would also pass along to you, to do your research and check out other PRCI videos, those from the Univerisity of California system and other high quality ones. Try to build a good team with a Urologist, Radiation Oncologist and Medical Oncologist to help guide you. What I'm learning, if you don't have a Medical Oncologist on your team as the honest broker, you can get siloed in Urology or Radiation oncology and not be aware of all of your choices. And as surprising as it might seem, some of the specialists are not up on the latest changes and best / best emerging practices.
To me, given your single 4+3 core on biopsy (putting aside the 3+3) and PSA of 4.1 you have time to research, get multiple opinions. Don't rush it. You only get one shot at your best first course of treatment. Hopefully, your team is going to have the Decipher or similar test done to help in your decision making. I would think if your Decipher were a 2.1 or a 8.1 it might influence your choice of treatment. You might be a candidate for focal therapy. I don't know if you are just locked into the radiation pathway or not.
I also note you only speak to a bone scan. Hopefully, they also performed some type of CT or Tc99m scan? With your low PSA and a single 4+3 core, doing a bone scan alone would be a head scratcher. I would reengage with your team and even if you have to travel to another city, get a PSMA PET/CT during your staging. As your future surveillance scans should you go with radiation therapy should / will be PSMA PET. Recent high quality study, Mar 2020, (focus on high risk not intermediate risk, newly diagnosed prostate CA) in the Lancet - proPSMA clinical trial clearly provides superior accuracy in comparision to combined findings of CT and Bone scanning. All the best to you and all of us on our Prostate Cancer journey.
I sent a lengthy reply earlier, but for some reason it is not visible this morning.
The short answer Gleason 4+3 =7=Grade 3 prostate cancer which is defined as unfavorable intermediate risk. That being said, putting the (3+3 core) aside, it appears that you have time to really do your research and learn all your treatment options, get multiple opinions if you can. Put your team together, your Urologist, Radiation Oncologist and a Medical Oncologist to help you with your decision and feel free to ask them Why and how does a test or therapy apply to your specific case.
I put a general post for all on this thread earlier. I had an initial meeting with a Radiation Oncologist this week. I had 12 sample biopsy done by my Urologist with 2 cores comming back 4+3, one was 3+4 and one was 3+3, the others were negative. He is sending me for PSMA Pet Scan to assist with staging. He also told me about ArteraAI prostate test that he could send my biopsy slides off for testing. If the test comes back negative then he said, short term hormone therapy would not be recommended.
That being said, speak to your Radiation oncologist about the trial that Dr. Scholtz speaks about and ask if your Rad oncologist is familiar with the Artera test and how these apply to your case of prostate cancer. Engage them in shared decision making.
Lastly, hopefully they did more than just a bone scan for your imaging. If not, I would engage with your team as to why they did not do some form of CT or Tc88 scan with it and that you would like a PSMA PET scan done. If they don't have it there, then where can they send you to have it done.
Regards to all of us on our prostate cancer journey
Thank you for the detailed explanation .
@@maxstyle3286did you have an MRI ? What does the lesion look like? Is it pirads 4 or 5 ? Your slides can be sent for another pathology opinion like Johns Hopkins and it's not unheard of for it to be downgraded. You do not want to get your situation overtreated or undertreated. Genetics can also be performed on the tissue to help you decide.
Yes , I did have an MRI . PI-RADS 4 , 7X6 mm rounded T2 hypointense lesion in the right posterorectal peripheral zone . Having said all that , I understand that the study shows that for Gleason 7 do not really have to do hormone therapy . By Gleason 7 , i understand 4+3 and or 3+4 . Am i right ?
Radiation caused severe side effects in our patient, rectal bleeding.
As mentioned above I just completed a regimen of Proton Beam Therapy and have had no rectal issues. I had to pee a bit more often at night with a bit of a “constricted” stream or flow, but that mostly went away after the first two weeks (used flo-max 💊then). I did have a “Space-OAR” before radiation which I highly recommend despite the short, Space-OAR procedure being painful. I did not find the previous biopsy painful at all, although it was a bit uncomfortable, but the Space-OAR (short procedure) was uncomfortable and painful, for me, but it was a quick procedure and again I recommend it to greatly reduce the chance of rectal complications from radiation
Dr Scholz would your assessment be the same for patients with Gleason 8, PSA
That is a great question. I’d guess that given the threshold level required for PSMA avidity, the docs have to guesstimate on chances of micrometastatic cancer escape from the prostate…and 4+4 might be too chancey for many docs.
What should I do now? I'm 69 years old. I was diagnosed in August of 23' with Gleason 10 and PSA 29.7. Had Chemotherapy, Eligard, and Nubeqa concurrently. PSMA Pet still positive with 4 bone mets and one pelvic lymph node but all significantly improved in size and intensity (SUV). My PSA is now 0.03. My options are radiation (either IMRT or Proton), another course of Chemotherapy, Xofigo, or Actinium. There is also a new treatment being studied from Clarity Pharmaceuticals using Copper 64 and 67. I would like Pluvicto but I'm not sure if insurance will approve it. I'm not sure what to do?
Thats a horrible situation to be in a nightmare, did u never get any psa's done before u where diagnosed, i hope everything works out for u
How do I find the best prostate Dr in our specific area. that's up on the latest research lik Dr Scholz is ? Do the research institute keep any kind of a list?
Riddle me this....If hormone therapy doesn't kill prostate cancer but only "pauses" it, then why implement radiation and ADT in low PSA individuals after localized recurrence confirmed with PET location? Once the radiation stops, if there are carcinoma cells remaining wouldn't they restart wherever they are?
It sounds like you are asking about the employment of ADT in the salvage setting (post prostatectomy with PSA recurrence)? If that's the case, the use of ADT is controversial if the PSA is less than 0.2 when going on the table for RT, albeit the SPPORT trial would support it. I chose to decline ADT when I had salvage RT last year as my PSA was 0.146 prior to starting RT. It is now < 0.006 ng/mL one year out. So far so good, but not out of the woods yet for sure. But yes, in theory, if any cancerous cells remain and don't die when trying to replicate (which is how radiation works btw) then in theory you could have a recurrence. The theory of why ADT works is it "weakens" the cancer cells to make them more susceptible to the radiation, but this effect seems less pronounced when the PSA is low (i.e. less than 0.2 ng/mL). Again, everything I've written refers to the salvage cohort which is not the cohort in the study Dr. Scholz is discussing in this video.
Good point. Docs get a little hazy when they “explain” how ADT and radiation actually result in better results than radiation alone in the recurrence setting. Sometimes they seem to “explain” that the ADT helps to wipe out the cancer (kind of odd since the radiation alone kills what it hits nowadays) and other time they “explain” ADT is systemic and suppresses cancer throughout the body. But, as you point out, how useful is that if it comes back when the short course ADT is over? Also, in many cases the use of ADT confounds attempts to gauge if the radiation was effective -one has to wait until the ADT is halted and testosterone returns.
What is ADT?? You’re not explaining?!
Good grief!!!! How many men died? This is how we do our medicine ne now?
Please clarify exactly how much true benefit to overall survival is gained by adding ADT CASTRATION for 6 months, for 12 months, for 18 months and for 24 months so men can carefully weigh the small benifit vs. the cost of the horrific side effects of this cruel and barbaric treatment that destroys quality of life and actually reduces life expectancy.
Men need the true facts before they xan give FREE AND FULLY INFORMED CONSENT.
Test the waters OF ADT???
BETTER inform your patients that testosterone recovery is undetermined and usually takes years and often results in permanent CASTRATION.
You have a duty to fully inform patients ABOUT ALL the horrific quality of life destroying and life shortening side effects. You should not be a promotor or salesman for big pharma.
Gee! Nuances! This kemo stuff is pathetic!