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

@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.

Excellent points and suggestions already. When I was diagnosed with locally recurrent PCa this summer, I faced a similar decision—salvage radiation with or without short term ADT? NCCN guidelines also indicated that ADT was a +/- treatment option in my case. I opted for no ADT after conferring with three oncologists (2 were pro ADT, one was agnostic). A very personal decision, and someone else may have opted for ADT.

Critical to my decision making was an evaluation of my desired "end points” as they say in the medical literature. What were my goals with treatment? Freedom progression at five year, ten years, more? Maximum life span? Quality life with whatever time I have left, be it three years, twenty years, or more (I’m currently 73)? And how did my wife feel about it all? Tough questions to answer, but they were really important and also helped me evaluate medical literature and clinical studies as they applied to my situation. I also discussed those goals with the oncologists.

My PSA at the time or recurrence was only 0.1 (previously was undetectable), and it remained the same when I started IMRT three months later. Scans and a DRE however confirmed a small lesion in my prostate bed. My low and stable PSA, and ten years between my RP and recurrence were factors heavily in my favor. If my PSA has been greater than 0.2, or risen between initial diagnosis and start of treatment, I may have decided differently about ADT.

Best wishes going forward.

I was 65y (5 years ago) when I went through this.

There has been so much reported on the physical benefits of exercise while on ADT. Here are just a few that I’ve bookmarked:

> Drs. Scholz and Moyad talking about exercise and hormone therapy: https://m.youtube.com/watch

> A paper on The Benefits of Exercise During Hormone Therapy: https://static1.squarespace.com/static/54c68ac6e4b06d2e36a4b8c9/t/55cb7275e4b0d97ae7ff60af/1439396469154/The+Benefits+of+Exercise+During+Hormone+Therapy_Insights+August+2015_PCRI.pdf

> A study about the benefits of exercise to counteract the adverse effects of ADT: (They describe a good resistance-training program): https://journals.lww.com/acsm-msse/fulltext/2023/04000/resistance_exercise_training_increases_muscle_mass.2.aspx

Maintaining muscle mass (as much as possible) while on ADT is key. But, always consult your family doctor before starting a new exercise program - especially if it’s an intense workout.

If you do what it takes, you’ll do very well with the hormone therapy - it’ll just be an annoyance; if you don’t do anything, hormone therapy can be your worst nightmare.

The RO is a Radiation Oncologist and trained in both disciplines.

I would follow the Dr's recommendation (and reluctantly did so myself).

For my Salvage Radiation Treatment, my RO recommended WPRT and 4 mos ADT (I took and would suggest Orgovyx if it is affordable for you).

I resisted the ADT. My RO thought that my result would be better with ADT. I hated it, but near the end of the treatment, if he said 2 additional months, I would have sucked it up and taken the additional ADT. That reflects my personal concern and uncertainty about fully treating my PCa.

If you do not trust the RO, get a 2d RO opinion. If he or she is going to be your treating physician, then their opinion should prevail

All in my Layman's opinion.

@melvinw
Great way to approach it. Quality rather than quantity is most important to me. Lots of grey areas with Pc.
Thanks for the response.

@michaelcharles
Thanks. I'm seriously considering Orgovyx as I hear the side effects drop off much quicker than Lupron once treatment has ended and also because it's a daily pill it's much quicker to stop if you do have really bad reaction to it.

@quaddick Big grey zone for me too. I will add that a major health priority for me is avoiding anything that increases the risk of cognitive decline (i.e, dementia and Alzheimer’s). A few recent studies have shown an association between ADT and increased risk of cognitive decline (one abstract attached). Given that adding ADT to my RT seemed marginally beneficial based on all my readings, the risks outweighed the benefits in my final analysis. Again, someone may have decided differently based on their risk tolerance and life/health priorities. Tough decisions with no one-size-fits-all answers, that is for sure.

@melvinw
It’s interesting that the study shows that while there is a higher chance of dementia or Alzheimer’s while on ADT the patients that were off of it also had a pretty high chance of getting it. The differences weren’t that great, At least the additional percentages of those that got dementia because they were on ADT was small compared to those that didn’t take ADT, since they also had a risk of getting Dementia.