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ADT, maybe not? Anyone opted out of ADT?

Posted by bob1955 @bob1955, Oct 28 6:20am

Has anyone opted out of ADT? I think its effects are possibly too much to sacrifice (at my age, or any age, maybe), but no one has tried to persuade me to have it. Yet.

3 weeks since diagnosis, age 69, 4+3, PSA 10.6, localized, one core, PSMA PET next week. Meeting RO today.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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heavyphil | @heavyphil | 10 hours ago
In reply to @pesquallie "@climateguy You need to be careful when reading the Duke report because they use the term..." + (show)
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@climateguy
You need to be careful when reading the Duke report because they use the term hormone when speaking of testosterone which technically is a hormone. It is confusing but based on the quote below they are saying that high doses of testosterone are best for aggressive difficult to treat prostate cancer.

"In recent years, clinicians have begun treating patients with late-stage, therapy resistant prostate cancers using a monthly, high-dose injection of testosterone in a technique called bi-polar androgen therapy, or BAT. The inability to understand how this intervention works has hindered its widespread adoption as a mainstream therapeutic approach for prostate cancer patients.

For the whole article see: https://corporate.dukehealth.org/news/study-solves-testosterones-paradoxical-effects-prostate-cancer

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@pesquallie Testosterone, hormone and androgen are all the SAME in this article. ADT blocks all of them.
So in early disease, blocking T is beneficial…it stops the cancer…however, in late stage it can produce the OPPOSITE effect and promote its growth. This is why it is called contradictory because giving T to a late stage patient should make it worse, not better. But they’ve found that it does, indeed, work by forming an odd receptor site molecule that blocks its growth. It’s weird, paradoxical and makes no sense, but there it is…
Hope that clears it up…
Phil

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pesquallie | @pesquallie | 7 hours ago
In reply to @heavyphil "@pesquallie Testosterone, hormone and androgen are all the SAME in this article. ADT blocks all of..." + (show)
Profile picture for heavyphil @heavyphil

@pesquallie Testosterone, hormone and androgen are all the SAME in this article. ADT blocks all of them.
So in early disease, blocking T is beneficial…it stops the cancer…however, in late stage it can produce the OPPOSITE effect and promote its growth. This is why it is called contradictory because giving T to a late stage patient should make it worse, not better. But they’ve found that it does, indeed, work by forming an odd receptor site molecule that blocks its growth. It’s weird, paradoxical and makes no sense, but there it is…
Hope that clears it up…
Phil

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@heavyphil

Phil,

Thankyou. I think you are right, but Duke has a hard sell because for 20 years doctors have been decreasing testosterone for aggressive cancer and their data shows some success. Duke is using AI to determine who this new BAT will help. It may be too late for me but it is great seeing that a lot of work is being done to improve treatments for prostate cancer.

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heavyphil | @heavyphil | 5 hours ago
In reply to @pesquallie "@heavyphil Phil, Thankyou. I think you are right, but Duke has a hard sell because for..." + (show)
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@heavyphil

Phil,

Thankyou. I think you are right, but Duke has a hard sell because for 20 years doctors have been decreasing testosterone for aggressive cancer and their data shows some success. Duke is using AI to determine who this new BAT will help. It may be too late for me but it is great seeing that a lot of work is being done to improve treatments for prostate cancer.

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@pesquallie Yes it’s amazing how quickly an accepted idea with years of acceptance becomes the exact opposite at a snap of the fingers- makes the head spin!!
But BAT is not for everyone, as you point out and there are new drugs coming out every single day to overcome the hurdles of this disease.
If you even think about your own treatment, it’s vastly better than what was done 20 yrs ago, right? It’s never too late until it’s really too late…not sure if Yogi said that but you know what I mean😉

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climateguy | @climateguy | 1 hour ago
In reply to @jeffmarc "@lamer25 Were you told you are pT3b? With seminal vesicle invasion that is the normal stage...." + (show)
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@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.

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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.

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