ADT: RO says I need ADT, Urologist says I don't.

By my reading the high Decipher score would suggest ADT. My experience is that urologists do not put a lot of weight on the Decipher score. I’d go with the RO.

I did six months of ADT and it's been a full year since I stopped and am still having SE's. My doctor said it can take up to two years to return to normal after six months of ADT and that most guys never go back to their pre-ADT T levels. That said, if you need it you need it. Just be ready for the long haul.

Your biopsy results look pretty good. The PSA is high, however, and the decipher score is very high.

If you can get Orgovyx for ADT It can be real beneficial. That’s because the testosterone level comes back very quickly, for most people, after stopping Orgovyx.

3 1/2 years after I had surgery and my PSA started rising they gave me a 6 Month Lupron shot, two months before giving me salvage radiation. I had no side effects at all from that shot, Didn’t even realize I should have had any. I was only 62 at the time that may be a factor

My brother at 75 had six months of Lupron And had side effects for about nine months after, because it took a while for his Testosterone to come back. It wasn’t something he couldn’t live with. It was just annoying..

I’ve been on ADT for almost 8 years, I’m 78.. I really have no side effects that bother me. I run on the track 1 mile twice a day and go to the gym three times a week. When I was on it for the first three or four years, I didn’t do any exercises, I did run a computer consulting company and was constantly on the run, Diving under desks was a normal occurrence, I think my activities kept me in good shape. The only side effect that bothered me was hot flashes, and my oncologist resolved that with a depo-provera shot every three months. Now, After almost 8 years on ADT the hot flashes are very seldom and very light. No one I know or meet has any idea I have prostate cancer.

Just some things to think about when you consider going on ADT for a short period of time.

You never said what is your age - if you are younger person, you would probably bounce back faster after 6 mos of ADT than an older individual. As far as I read it also can depend of an ADT type. Orgovyx seems to clear from body much faster than injectables. It is really a hard call and if your Decipher was lower than avoiding ADT would perhaps make sense, but with aggressive cancer ADT might offer extra benefit.

Wishing you the best of luck with whatever you decide.

(With a localized, PSA of 7.976, Grade Group 3 (Gleason 7=4+3), I had 28 sessions of proton radiation + SpaceOAR Vue + 6 months of Eligard.)

The general rule of thumb is that side-effects of ADT will subside at the end of the prescribed number of months + 50% more months. (In my case totaling 9 months; that was easy to deal with.) Note that most side-effects of ADT can be minimized/avoided with resistance-training exercise.

I generally take these things step-by-step —>
With a Grade Group 2 (Gleason Score 3+4) NCCN guidelines do not call for hormone therapy (ADT). (See attached NCCN guideline chart for favorable intermediate risk group prostate cancer.)

However, if it were me and I had any other risks beyond just a vanilla Grade Group 2, I would bump that treatment up a notch due to the PNI - just out of caution.

Also, with a PSA that spikes above 10 sometimes, that would be another increased marker that would lead me to bump up the treatment regimen slightly.

And, with the 0.81 Decipher score, that would be another increased marker that would lean me towards bumping up the treatment regimen slightly.

Regarding the PSMA PET scan results, what were the SUVmax scores?

Bottom-line:
> with a vanilla GG2, if it were me I might side with the urologist.
> but, considering the increased risk factors (markers), if it were me I would side with the RO.

But, I’m a more precautionary type. Weighing the potential benefits against the quality of life concerns, 6 months of ADT (with a robust resistance-training program) would be an easy decision for me to take the ADT.

(Do you have any cardiovascular concerns)?

I completed SBRT x5 in July. We shared similar numbers but I also had cribriform plus a couple other negative factors. Even with that -I did not undergo ADT. Now there are those on this site who strongly disagree but my faith still remains in my RO who said “the possible minimal benefits of ADT are outweighed by the almost certain negative side effects.” Treatment also included MRI guided radiation plus Barrigel. Best of luck with your decision and treatment.

@jeffmarc

@surftohealth88
I'm 66.

@brianjarvis
Thanks. No, I don't have any cardiovascular concerns. I'm already kind of active. I walk 4 to 7 miles a day, and do some resistance training with 10lb dumbbells 3 times a week, and squats with the same dumbbells. I don't know if that's enough. I'm 66 by the way.

@quaddick
According to professor Rob Newton, who spoke at the PCRI conference, but I’ve heard from him many other times, That’s not enough weights.

You might look up his speeches they can be found on YouTube and other places.

He found that doing the correct weight training extended the lives of many people with prostate cancer.