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@clandeboye1

@heavyphil. Sorry I am not aware of which ADT they were on . Both passed 4 plus years ago .
One was two months shoort of his 90th birthday , Google : Dr. Hamish Small , a distinguished world renouned research scientist . His brothher passed at age 86 . Both were in excellent physical and mental health -- No pre existing issues , And both very active in : walking , golf , cross country sking , kayaking etc . Both surprisingly discontinued having a PSA . Hamish's cancer was diagnosed following a concerning " Alkaline Phosphatase number . Ian , from other indicators and finally a Biopsy . Both were Stage 4 when diagnosed . Both lived less than 2 years after diagnosis .

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Replies to "@heavyphil. Sorry I am not aware of which ADT they were on . Both passed 4..."

@clandeboye1, Well, both in-laws were at an advanced age; and many much younger, active people die from heart attacks and strokes as well.
On autopsy, their arteries are completely clogged but because they were young and healthy no one suspected a thing, including their doctors. Perhaps your in laws were never even given physicals to address their cardiovascular condition before hormonal therapy, right? Who knows?
But metastatic cancer to the bone does a LOT to the body even when hormones are not involved. The high AlkPhos is a pretty good indication that your one in-law had a very advanced case.
Personally, I believe hormones have a very valuable place in the treatment of PCa; that said, I do not think they should be used in all cases. In fact, recent retrospective studies show lack of efficacy and even harm in some men whose recurrent PSA (post primary treatment) is less than 0.7
I am one of those men (PSA 0.18) yet I chose salvage radiation WITH ADT because I did have a full medical screening beforehand and I did want to give my RO every tool in the toolbox to beat this thing. How foolish would I have been to go thru 25 sessions of IGRT, have the cancer come back yet again, and hear the RO say, “Gee, maybe we should have used ADT as well…”. TOO LATE!!
Now I’d have to be on even more powerful drugs - some really full of side effects - or possibly ADT for life.
So that’s why I caution against saying “stay away from hormones” because they really CAN make a difference and change outcomes in many cases. I’ve got my fingers crossed, but come what may I have no regrets with my decision.
Phil