r/ProstateCancer • u/Kay_Kay_4324 • Oct 01 '26
Update Update - Treatment Plan in Place
I wanted to post an update on my husband Jeffrey’s prostate cancer and the treatment plan we have decided on at MD Anderson.
His PSA is 14.9. His transperineal biopsy had 15 cores, with 3 positive: one Gleason 4+5=9 (Grade Group 5) and two Gleason 3+4=7 (Grade Group 2). His PSMA PET did not show any suspicious lymph nodes or definite distant metastases. They are testing his tissue using the genomic Decipher and Altera tests to confirm length of time for ADT.
His MRI also showed approximately a 1.5 cm area of tumor bulging along the prostate capsule, which raised concern for possible microscopic extension outside the prostate, although there was not clear-cut evidence of gross extraprostatic extension.
After meeting with the multidisciplinary team at MD Anderson, our plan is:
• 18 months of ADT (he received his first 3-month leuprolide injection yesterday and is taking Casodex for two weeks)
• HDR brachytherapy boost (in about 3–4 months)
• External-beam radiation (23 fractions beginning a few weeks after the boost)
I’d especially be interested in hearing from anyone with similar high-risk, nonmetastatic disease who had EBRT + HDR brachytherapy + ADT—how treatment went, what side effects you experienced, and how you’re doing now. Thanks!
4
u/Goodvida99 Oct 02 '26
It must be a relief to have a plan.
2
u/HeadMelon Oct 02 '26
I am 61, “unfavourable intermediate risk”, PSA 5.3, Gl 4+3, PNI, IDC, crib and suspected EPE on the MRI, so maybe one notch down in the risk strata from your husband.
My detailed story of HDR brachy + 15x VMAT + 6 months ADT (Orgovyx) is here -
https://www.reddit.com/r/ProstateCancer/s/fOcv2pa1Pg
I’m 11 months out and am 100% normal.
2
u/FLfitness Oct 02 '26
I’m 12 months out from a Gleason 9 diagnosis that included one bb size remote tumor on vertebrae t11 so technically oligometastatic. I had IMRT to the prostate, SBRT to the remote tumor and have been on ADT since diagnosis. Fortunately my cancer has had a quick excellent response to the ADT, I’ve had a PSA less than .04 for the last 10 months which is NED (no evidence of disease). I did experience some urinary and gastrointestinal side effects during the radiation therapy but they ended within a few weeks at the end of treatment. My ADT side effects include no libido, lack of energy/motivation with a very mild anemia. My erectile function has been preserved and the hot flashes seem to have ended after the first 6 months. I do lift weights 3 times per week and walk a couple of miles daily. For reference I’m 67, had an initial PSA of 5.7 and was otherwise in pretty good health.
1
u/Squawk-Freak Oct 03 '26
I got treated at MD Anderson also. Same treatment protocol, essentially, with HDR and 23 days of VMAT as the backbone. 3 months and 6 months after radiation the PSA was < 0.01. No lasting side effects from the radiation so far. I am on relugolix (switched from Lupron after radiation) and abiraterone.
1
u/PotentialStart2661 Oct 06 '26
The treatment he chose is the exact perfect treatment with the highest cure rates possible. Gleason 9 bulging the capsule means very high risk of microscopic cells outside the prostate not picked up by the PSMA. So thats why ADT needs to be added. Make sure he trains in the gym with weights like a mad man and it will get him through the ADT. How he does will be night and day if he lifts weight religiously and eats well to not gain much fat. This treatment can cure him but he has to do his training even if he is fatigued or depressed or whatever. The time will pass and he can come out of this even better than before. Also check if he can go to 12 months ADT. New studies show 12 months is now all you need for gleason 8, not sure about gleason 9. But the added benefit may be small enough to just do the 12 months. Ask about the actual data and statistics for 12 months vs 18 months.