Al,
Firstly, I wish you all the best with your treatment. I am now 10 months into my treatment for advanced prostate cancer. I had IMRT and seeds 7 1/2 years ago, recurrence in February last year (2024), localized to pelvic area. I eat very well (Mediterranean and anti-inflammatory diet) and exercise a lot. Mayo (Dr. Kwon) diagnosed metastatic cancer last year and scheduled radiation and ADT (Eligard) + Zytiga. I had a bit of a stomach issue at the end of the radiation cycle (15 treatments over 3 weeks), but that was it. Fast forward to Feb this year (5 months later) I had a heart attack and had 4 stents inserted. Cardiologist discontinued the Zytiga due to its potentially negative impact on my heart (known possible side effect). Dr. Kwon concurred. - Track your heart health closely, especially if you have a family history (which I do). Due to my exercise history, I had little heart damage. Now I am also on a bunch of heart meds (Beta Blockers, Cholesterol lowering, blood pressure lowering and anti-platelet) meds. Hence, it is difficult to know the effects of ADT vs the heart meds. Hot Flashes (clearly from ADT since these started before my heart attack), fatigue (started with ADT, but got worse after the heart attack), and sleep issues. My solution is built around the four most stressed remedies: Sleep, Exercise, Diet and Social Activity/Stress management. These are very interrelated. If I have a light dinner with no alcohol and good exercise, I can sleep better. If I sleep better, I feel more like getting going during the day with exercise. Social activities help with stress but I need to manage them to keep the stress out of the equation. Exercise, for me, needs to be more than casual walking (I do that with my wife and my dog 1.5-2 miles on hilly terrain 5-7 days/week). I mix in more intense exercise 3-5 days/week with weights, rowing or paddling (hard enough to get my heart rate to 138 or so, which is all I can do with the Beta Blocker). This has had a big impact on reducing my fatigue - I now can make it through the day without that mid-day slump. It's all a huge effort, but luckily, I'm retired so I have the time for it all.