How to decide what next for ADT?

Great synopsis.

thanks for the input I had robotic surgery 6 years ago and until Jan of 23 my psa was 0 but it has been increasing every test till last month when it jumped from 2.4 to 3.4. I am not being encouraged to go on ADT Between my surgery and radiation I was detected with a non related kidney cancer and had my right kidney removed. During this time I was placed on Eligard and it hit me lit a sledge hammer. Are the other alternatives easier on a person than Eligard

I’m relatively new to this, but have been on Orgovyx for five weeks now. I'd say a week or two in I felt a little "testy" or out of sorts, but my wife says I didn’t get ugly with her…although she says she could see I was edgy at times more than usual. That passed and other than fatigue (which can also be attributed to a couple other diseases I fight) my main side effect has been hot flashes. Multiple times a day and night I’m suddenly drenched in sweat.

Overall, it’s been easier than I expected, but maybe that will change with time…I just don’t know.

All good advice. Ku Jayhawk hit on my thought that the rising psa might be useful in that you may be able to get petscans with a high degree of accuracy and possibly locate the source and determine if it can be treated locally. Ending adt is in my future in an attempt to locate sources with higher probability scans due to higher psa. Best wishes in your journey.

I was on Lupron injections every 3-months for 2-years.
Worst for me are the hot flashes. Like gimmick I'm all of a sudden drenched with sweat. I use Paroxetine to help those somewhat.
Overall, no 'sledge hammer' with Lupron for me.
Good luck and keep trying to get the best that fits YOU.

Dear all,

Thank you all so much for your helpful infomation and sharing your experiences. I am now handing over the baton to my husband, who is dealing with all this. For the female partners, just ask him to notify me if you need any input from me (the wife ;). Wishing you good health and happiness.

Thank you all for sharing your experiences and insights. For now I have still some time to contemplate what ADT regime to go for. Anticipation of acceptance of the possible side effects will be my struggle. My experience with my prostatectomy is that I adapted remarkably easy to the new normal (with a lot of support from my dear partner), essentially having lowered the bar of what I thought to be acceptable for quality of life. And now I will have to lower that bar again. But the alternative of doing nothing is deemed high risk: known outcome but unknown time span. At 66 years of age and healthy otherwise, I should not take that chance.

No disagreement on "no one here is an expert..."

I am not sure about the "I would get truly expert advice and then follow it..."

Had I done that, I would have on mone-therapy vice triplet therapy, likely become resistant, then a downward path from there. I did listen, decided that was not the best choice nor it was it the best recommendation, it was perfunctory care..

Clinicians should not unduly interfere with allowing people to make informed decisions about their health and life consistent with their values, interests, and preferences.

Respect for autonomy does not exist in a vacuum, and leaving patients alone to navigate health care decisions would relinquish clinicians’ responsibility for promoting patients’ best interests.

Even as patients are encouraged to be the ultimate decider on what is done to their body, it is the clinician who possesses the medical expertise to advise them on making that decision.

Clinicians can balance these professional obligations to patients by engaging them in shared decision-making (SDM), “an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences.”

This model recognizes both that the clinician possesses expert medical knowledge and should not be relegated to a bystander role, and that patients have expert knowledge of their own lives, values, and interests to help inform and guide the decision-making. This model is also designed to avoid the undesirable extremes of patients as completely passive participants and clinicians serving solely as information purveyors without any advisory role.

People have innumerable sources for gathering medical and health information, but when they come for a medical evaluation, they generally want, and believe they will benefit from, clinician recommendations, not simply a laundry list of medical options. The shared decision making model advances clinicians as guides to the medically appropriate options while respecting and recognizing patients’ values and preferences. This promotes both quality care and respect for patients’ autonomy.

Kevin

Kevin. I have reservations about Mono therapy being the present standard of care at an excellent facility for most G7 or greater PC. Three years ago, when I started with care at UCLA , they aggressively started me on Lupron, and Erleada for 6 months then Robo surgery then 6 more months of these meds. If they started me on a non aggressive mono therapy for my G9, locally advanced, NM, PC, I would have asked why they were being so gentle with me ( they may have had a good reason) and I would have also sought a second opinion from a new excellent facility. Generally, following my expert medical team’s advice is, I think, wise but doing my research and asking questions and being satisfied with the answers and sometimes seeking a second opinion is necessary. These are tough, life threatening decisions for all of us here. When I get to an impasse and do not have a firm belief of the right path forward, I make sure that I have an unemotional faith in my medical team and then follow their educated, seasoned advice and hope that they and I made the right decision.