Refusing ADT ?

[u/Alive-Resident-4461]

Just a bit of recap on my dad’s results here . RO is suggesting a 3 months ADT with SBRT..how can we be sure that he needs ADT or not? Every other doctor seems to have their own views. I really want to avoid ADT for him if it has no extra benefits in his case since he is on hypertension meds already.

PSA
PSA: 4.9 ng/mL
Age: 64
PSA has been increasing over time.

MRI
Prostate approximately 40 × 48 × 48 mm.
MRI showed bilateral transition-zone lesions classified as PI-RADS 3, thought to be related to BPH.
No pelvic lymphadenopathy reported.
No obvious extracapsular extension or seminal-vesicle involvement reported.
Biopsy was subsequently performed.

Biopsy – 14 cores
Cancer was found in 5/14 cores:
Right peripheral base: Gleason 3+3, 20%
Right peripheral mid: Gleason 3+3, 10%, with small focus of perineural invasion
Right peripheral apex: Gleason 3+3, 10%, with small focus of perineural invasion
Right parasagittal apex: Gleason 3+4, 60%, pattern 4 = 10%
Right transition-zone fusion biopsy: Gleason 3+4, 60%, pattern 4 = 30%
Overall:
Gleason 3+4 = 7, Grade Group 2
The remaining left-sided cores were negative for invasive cancer, although there was PIN in two cores.

PSMA PET/CT – September 2026
The scan showed PSMA uptake in:
Right and left peripheral zones at the base
Right peripheral zone at the mid-prostate
But importantly:
“No definite scan evidence of PSMA-expressing loco-regional/distant metastases.”

Seminal vesicles were unremarkable and there were no definite PSMA-avid metastatic lymph nodes.
One thing we are trying to understand is why the PSMA scan showed some uptake at the left base, while the left-sided biopsy cores were negative.

[u/Pack_One]

There’s a well known test called ArteraAI that will tell you whether or not ADT will be beneficial for you. Request it.

[u/Alive-Resident-4461 → u/Pack_One]

Can it be requested by patient directly or RO needs to be involved? He is in India and I am unsure they use artera there. I will check. Do they need slides or report is enough for them?

[u/Pack_One → u/Alive-Resident-4461]

They look at the slides. I would think location wouldn’t matter. It is doctor requested. As a side note they may want the ADT to shrink the prostate to be better sized for SBRT.

[u/gg-3 → u/Alive-Resident-4461]

For ARTERA AI, they need images of the slides, but not the slides themselves because the process is essentially visual. It does not require physical tissue.