ADT, Hot Flashes and Ashwagandha: Is it safe?

@slowdo, you're right that ashwagandha may increase testosterone levels. So it's important that you talk with your doctor if you have hormone-sensitive prostate cancer. Ashwagandha can interfere with your treatments.

When researching supplements and herbs related to cancer, I check the Memorial Sloan Kettering's website: About Herbs, Botanicals , etc. https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs.

Here's the article specifically on:
- Ashwagandha https://www.mskcc.org/cancer-care/integrative-medicine/herbs/ashwagandha
- The Truth about Ashwagandha and Cancer: Answers from an MSK Expert https://www.mskcc.org/news/truth-about-ashwagandha

And also from Mayo Clinic
- Mayo Clinic Q and A: Can ashwagandha supplements help with stress and anxiety relief? https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-can-ashwagandha-supplements-help-with-stress-and-anxiety-relief/

Like you, I couldn't find any guidance about using ashwagandha AFTER completing treatment. That sounds like a question for your oncologist. I'd be interested in hearing what you learn.

Do you consult with someone in integrative oncology at your cancer center?

My oncologist prescribed Depo-provera shots every 3 months when I had severe and quite frequent hot flashes. It worked great until I went on Zytiga, And then it only worked a little. It does not cause breast enlargement like some other hormones.

Ask your doctor about hormone options for the hot flashes.

@colleenyoung Thanks for the response. Yeah, I check MSK on occasion for medical info. I will definitely ask my med. onc. about it. I see them soon and I'll report back. I should also look into integrative or complementary oncology.

@jeffmarc Will do! Thank you!

Your question is “is it safe to consume ashwagandha at this stage in my treatment?” You also mention “Sources always stress not to take ashwagandha during ADT, but never mention AFTER therapy.”

At what point do you consider being “AFTER therapy.”?

Remember that radiation damage to DNA continues long after the radiotherapy itself has been completed; this is why they keep you on ADT for some time after radiation treatment ends. ADT is a very important component to kill prostate cancer cells.

Right now your PSA (at < 0.01ng/mL) is being artificially suppressed by the ADT. Increasing testosterone now (with Ashwagandha), might not be the best course of action - because cancer cells are possibly still present. Waiting for many months after you’re off of ADT, and are confident that your PSA is stable and no cancer cells remain, might be a more cautious and prudent approach.

So, back to the question: “is it safe to consume ashwagandha at this stage in my treatment?” The answer depends on when you’ve actually “completed treatment.”

(For my localized 4+3, I had 28 proton radiation treatments (April-May 2021) + 6 months (two 3-month injections in April & July) of Eligard. At my 2nd (& final) injection, my PSA was < 0.008ng/mL. (My testosterone remained suppressed for an additional 3 months beyond that 6 month Eligard window.) Having ramped up my resistance-training (weightlifting) program prior to the first injection, I had only mild warm flashes.)

Good luck with your decision.

@brianjarvis, good question: At what point is one considered AFTER treatment. @slowdo, maybe another question to ask the med onc.

Additionally, here's some info on integrative oncology. More and more cancer centers and oncology specialists are open to discussing and integrating complementary medicine in programs called Integrative Medicine or Integrative Oncology. Integrative medicince is offered at many cancer centers of excellence, including Mayo Clinic.

Here's a link to more information about Mayo Clinic's Integrative Medicine programs
– Integrative Medicine and Health https://www.mayoclinic.org/departments-centers/integrative-medicine-health/sections/overview/ovc-20464567

@slowdo, I look forward to your report back after your visit with med onc.

@colleenyoung I think that for some, that integrative medicine approach may be helpful. For me, as it relates to my prostate cancer journey, my mental, emotional, and spiritual well-being are quite sound and well-grounded; conventional medicine has worked well (so far).

As yet, I’ve not experienced fatigue, nausea, or pain, and the only times I experience anxiety are are few moments after my MyChart notifies me that I “have a new < PSA> test result.” Other than that, this journey has been relatively benign (having caught my prostate cancer early due to early and annual testing).

Though I’m not much into herbs, meditation, or wellness coaching, I have incorporated supplements, massage, movement (exercise), and nutrition into my daily routine. (I’m not quite sure what “resiliency” refers to; and I plan to see if acupuncture is covered by Medicare.)

Since the last 3 month Lupron injection was in June, I would assume "treatment" ended around September, so it has been 2 months off of treatment? I would also assume that PSA will begin to rise on its own at this point. How do you judge when treatment is done? Still suffering major hot flashes and poor sleep quality. I'm looking to get a little additional boost to the natural increase in testosterone with the hope that this will bring some control to the hot flashes. As I understand it, you don't want more than a 2.0ng/ml rise in PSA after ADT with an intact prostate. I'll be getting the ultrasensitive PSA blood test in a couple of weeks and I believe the plan is to get a test every three months, so I should be able to monitor the PSA regularly.

I was 2 years on lupron 3mo injections. off now 3 months.
I take gabapentin and black cohosh for hotflashes and night sweats

@slowdo If you’re tracking testosterone (T) levels, that will indicate when treatments have ended.
> what was your T level before starting ADT?; what is your T level now? (If T levels are still low, that may explain why you’re still suffering major hot flashes and poor sleep quality.)

Your PSA should increase slightly once the ADT leaves your system and T levels begin to rise significantly. I would wait until then before considering a testosterone boost,

Actually, a 2.0ng/ml rise in PSA above nadir (called the Phoenix Criteria) is the clinical definition of biochemical recurrence (BCR) following initial radiation. That’s a number you don’t want to reach. (See attached chart showing my PSA at the start, during, and since radiation. If my PSA ever exceeds 1.0ng/dL, we’ll start discussing next steps well before a 2.0ng/ml rise in PSA has occurred.)

In addition to regular testing of Total PSA going forward, you’ll want them to also test and track:
> Free PSA
> PSA Velocity
> PSA Doubling Time

> A separate question: Did you have a DEXA scan prior to starting ADT?

Also, they should be checking all of your other bloodwork (i.e., CBC & CMP) to ensure that the radiation treatments haven’t caused any other issues.