I think it IS worth it, especially since it’s usually for a short period of time - hopefully only 6 months but maybe as long as a year.
The most important factor is the overall health going into treatment. Co-morbidities like brittle diabetes, difficult to control hypertension, cardiac disease, etc absolutely put you at risk for very serious ‘events’ (sometimes fatal) when combined with ADT.
However, conditions well controlled by medication put you at a much lower risk for adverse events - almost even with the general population.
I look at it this way: if that 10% extra chance at a cure keeps the cancer away for the rest of my life, it is worth TEN TIMES that…because, if the cancer returns after radiation with NO ADT, you will most likely be on testosterone suppressing drugs for the rest of your life; and the quality of that life will probably deteriorate the longer you take the ADT. A vicious cycle which might have been prevented…
Phil

I have been going over this in my mind for and after getting my PET scan which showed the cancer is limited to my prostate which is very large but at the same time my cancer is aggressive as indicated by my Gleason score of 8 (4+4) and my decipher score of .84 I have decided that hormone therapy is worth a try. I am taking the ORGOVYX Pills so my Doctor said I could stop them if I can’t tolerate the side effects. He wants me to try and take them for six months but with a goal of two years if possible. I have only been on them for three days so no side effects yet and I am doing daily workouts with hopes of countering the side effects. This is really a personal decision that everyone has to make but for me when I saw my granddaughter breakdown because I had not yet made up my mind that pushed me to give it a try.

I’m 77 just like @cobratk
Someone can avoid hormone treatments and see if their PSA rises after radiation, it should fall steadily. I didn’t have ADT after radiation, It took 2 1/2 years before it came back and I had to go on hormones.

Hormones can affect you 100% when it comes to living. Unfortunately, you don’t know where you stand until much later in your life. Taking the hormones after radiation prevents cancer from coming back sooner, It doesn’t kill the cancer.

I know that if I stopped the drugs, I am on now I probably wouldn’t live another two years. My PSA has risen very rapidly if I just cut back on the drugs I take. Stopping them Would really accelerate the PSA rise.

Of course the answer depends on the patient. I’m one that’s not a good idea for. Someone with a Gleason eight Might be just fine, not taking hormones.

For intermediate risk prostate cancer, as this interview (https://youtu.be/cyY0nHXvzGc?si=En9UL6H_Bb27FVE9) and this study they’re talking about (https://pubmed.ncbi.nlm.nih.gov/37104748/) point out, as far as overall survival (OS), the benefit of using ADT is minimal. It might lead you to believe that such a small % improvement in OS might not be worth it.

However, as the study concludes, though there was only small improvement in OS using ADT, there were improvements using ADT in metastases rates, prostate cancer deaths, and PSA failures.

So, one probably should not only weigh the risk of OS, but the risk of all adverse events against the impact of ADT on quality of life.

Also (unless I missed it), neither that interview nor the paper indicated whether by “intermediate” they meant “intermediate favorable” or “intermediate unfavorable”?

If they only meant “intermediate favorable,” ADT isn’t usually used in those cases anyway so, the study simply substantiated current practice. However, if they meant “intermediate unfavorable,” then the study conclusion may be significant.

And if the study involved a mix of intermediate favorable/unfavorable, the % mix would be of interest.

Remember too that many QoL side-effects of hormone therapy can be minimized in various ways.