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ADT, maybe not? Anyone opted out of ADT?
Prostate Cancer | Last Active: 1 hour ago | Replies (84)Comment receiving replies
@lamer25
Were you told you are pT3b? With seminal vesicle invasion that is the normal stage.
Here are the USA guidelines for ADT.
You should notice that T3 requires at least 12 months. Not 24 months however, with your other low grade prostate cancer issues. Some doctors like to be more careful about spread.
Here are current NCCN Guidelines in 2025. They now suggest 0 (zero) months of ADT for low intermediate (GG2); 4-6 months for high intermediate (GG3), and 18-36 months for high risk (GG4 and 5). Actually, the footnote suggests ADT + abiraterone for T3b with lymph node involvement.
The meta-analysis suggests:
* 0 months for 1 intermediate factor (PSA 10-20, GG2 or 3, T2b-c)
* 6 months for 2 or more intermediate factors (PSA 10-20, GG2 or 3, T2b-c)
* 12 months for NCCN high risk (PSA >20, GG4 or 5, T3 or 4)
* undefined for NCCN very high risk (2 or more PSA >40, GG4 or 5, T3 or 4)
Keep exercising that defeats the fatigue from ADT.
Replies to "@lamer25 Were you told you are pT3b? With seminal vesicle invasion that is the normal stage...."
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@jeffmarc How do you get a description of current NCCN guidelines this specific? I go to the NCCN site, log in, and can't access anything like as easy to understand as what you've laid out.
One thing I'm trying to track down at the moment is exactly what the NCCN guidelines say about brachytherapy.
I can get a general AI generated "2025 NCCN guidelines recommend a combination of treatments such as surgery, radiation therapy (sometimes with a boost from brachytherapy), and hormone therapy, tailored to the individual patient's risk factors and age".
But I would like to see details, such as NCCN guidelines for something similar to my "PSA 7.7, cT3b, GGIII (4+3), 5 of 12 cores, biopsy indicated seminal vesicle involvement but no PNI or EPE, "no evidence of metastasis" on PET but "no prostate uptake" of the radioactive indicator seen by the PET, case. My doctors agree my case could be described as "localized", and they call it "high risk".
Doctors advocating a brachytherapy "boost" for high risk cases say less time or no time on ADT is required when a brachytherapy boost is added to standard EBRT, for a superior result, compared to EBRT + ADT without such a boost.
They point to a major advantage of brachytherapy boost, which is less or no time on ADT. Less time on ADT for a superior result interests me quite a bit.