And.....We're Off.......

FULL DISCLOSURE, LONG POST
Ok, here I go. You may remember me from my “Andre the Giant” post.

Had a TRUS biopsy end of September after AS of a rising PSA. Had a 3T MRI in November 2021 which showed a PIRADS 3 left base and PIRADS 2 right mid and prostate volume 40mL. 4K in August of this year was 57.1 with PSA of 7.8.
DICIPHER from biopsy was .84.
Clinical stage T1CN0M0 negative DRE. On the cusp between intermediate favorable/unfavorable with 4+3=7 tipping me into unfavorable.

Local path report significant findings:
A) PROSTATE, LEFT BASE, BIOPSY: Histologic Type:
Prostatic adenocarcinoma
Histologic Grade: Gleason's grade 4 + 3 =7
Grade Group: 3 (of 5) Cribriform Pattern: Present
Tumor Volume:------
Number of cores positive: 1
Total number of cores: 2
Total linear mm of carcinoma: 4.2 mm
Total linear mm of needle core tissue: 25 mm
% of prostatic tissue involved by tumor: 17%
B) PROSTATE, LEFT MID, BIOPSY:
Histologic Type: Prostatic adenocarcinoma
Histologic Grade: Gleason's grade 3 + 3 =6
Grade Group: 1 (of 5) Tumor Volume:
Number of cores positive: 1
Total number of cores: 2
Total linear mm of carcinoma: 1.6 mm
Total linear mm of needle core tissue: 25 mm
% of prostatic tissue involved by tumor: 6%
F) PROSTATE, RIGHT APEX, CORE NEEDLE BIOPSY:
Histologic Type: Prostatic adenocarcinoma
Histologic Grade: Gleason's grade 3 + 3 = 6
Grade Group: 1 (of 5) Tumor Volume:
Number of cores positive: 1
Total number of cores: 2
Total linear mm of carcinoma: 0.5 mm
Total linear mm of needle core tissue: 20 mm
% of prostatic tissue involved by tumor: 3%

Mayo path report (second opinion)
A) Prostate, left base, needle core biopsy:
- Prostatic adenocarcinoma.
- Type: Acinar.
- Grade Group and Gleason score: Grade Group 3 (Gleason
Score 4+3=7).
- Percentage of pattern 4: 50-75% Tumor involves 17% of overall specimen (1 of 2 cores). Most affected core is involved by tumor over 30% of its length. Perineural invasion is identified.
B) Prostate, left mid, needle core biopsy:
- Prostatic adenocarcinoma.
- Type: Acinar.
- Grade Group and Gleason score: Grade Group 1 (Gleason Score 3+3=6).
- Percentage of pattern 4: NA Tumor involves 6% of overall specimen (1 of 2 cores). Most affected core is
involved by tumor over 15% of its length.
- Other findings: Atypical cribriform proliferation, suspicious for intraductal carcinoma.
F) Prostate, right apex, needle core biopsy:
- Atypical small acinar proliferation, suspicious for adenocarcinoma

PSMA PET 4 days ago shows PC confined to prostate and only on left side.
After meeting with Uro and radiation oncologist I am moving forward with RT. I believe I will have a better quality of life with RT.
Treatment will be SpaceOAR, SBRT with focal boost and urethra sparing, 5 sessions over two weeks and ADT for 6 months as I am intermediate unfavorable. Prophylactic Flomax.
Main concern is looking, feeling and acting like a little old man from ADT, and I am not ready for that. But it is only for 6 months……. One percent of my adult life……Going with Orgovyx over Lupron as it avoids the testosterone spike, reached castration level suppression much faster, has less cardiac toxicity and testosterone levels return much more quickly at the termination of therapy. And…it puts me in control as I choose to take the pills….it is important for me to feel some modicum of control on this rollercoaster.
I am 68, active and in good shape.
My Pre-ADT workout (basically the workout I have had for years)
Three days a week:
25 pullups
20 minutes fairly intensive elliptical (heart rate 140-150)
15 minutes planks, Russian twists, dead bugs, leg circles
35 minutes weight machines
10 minutes stretching
Walk 18 holes of golf once a week.
Three to five days a week walk 3-4 miles.
I intend to keep this workout and watch calories to combat weight gain, bone density and muscle loss.
Having the SpaceOAR and fiducials placed in two weeks, simulation workup following week and likely start SBRT after Thanksgiving.
I will report back along the way.
Good luck to all of us, keep fighting the fight, and Fuck Cancer.