First let me thank the board for all the information and support that was offered after my diagnosis. Despite being a 70 year old physician, your viewpoints were valuable from the very start in 2021. Briefly, my diagnosis arose following an updated rectal exam since my younger brother was diagnosed with prostate cancer. He chose treatment with seeds and external beam radiation (plenty of bowel and bladder side effects for him). To my suprise, my PSA was 9.8 and my biopsy showed gleason 5+4 on multiple biopsy
locations. All the preop evaluation was negative. I really hoped for definitive treatment and chose RARP. The radiation therapist had suggested radiation and 2 years of ADT. Surgical path showed pT3b with involvement in both seminal vesicles but no capsular extension. Post op PSA was .123 with a doubling time of 60 days. This was August 2021 and I had to drive to Charlottesville Va. to find a Pylarify PET Scan which showed a solitary pelvic lesion. Still resistant to longer acting ADT (Lupron), I chose 6 months of Orgovyx (despite the cost after insurance of $1500/ month at that time) and 8 weeks of SRT. I am now 10 months since SRT completion and 8 months off Orgovyx. My PSA has been undetectable and Testosterone levels were back to normal within 30 days off Orgovyx. I wanted to avoid if possible lingering effects of ADT which I did not tolerate well. I know there is a significant risk of BCR in light of the high grade lesion, but I think my approach gives me a clear view of my cancer status at this time. Should I get a PSA bump, then I will repeat the Pylarify scan and treatment (Orgovyx and SRT) if the lesion is solitary and accessible. These were my decisions but supported by my urologic surgeon. Warmest wishes to everyone.
Post Edited (Dr.V) : 2/18/2023 8:09:35 AM (GMT-8)