Continued hormone therapy? or not?

With a 3+4 they usually don’t recommend any ADT.

3.5 years after my surgery my PSA started rising, so I was given 8+ weeks of radiation. I was a 4+3. They gave me a six month shot two months before the radiation and none after. I didn’t have any more ADT until 2 1/2 years later when my PSA rose too much again.

Normally a 3+4 wouldn’t need additional ADT, But you had to have Radiation because your cancer had spread to more than just the prostate. In that case, some doctors want to go a year to a year and a half with ADT. It’s very possible that Prostate cancer has entered your bloodstream because it had spread beyond the prostate. You could still go into remission for many years, Sometimes it becomes dormant and doesn’t come back for decades, Continuing ADT would suppress the cancer from coming back for a longer period of time. It may not be necessary ask the doctor that wants you to go on ADT longer why?

I’ve been on ADT for eight years now. Really not had much of a problem with it. Had a lot of hot flashes in the beginning, but those are gone. I do run on a track a mile twice a day and go to the gym three days a week. I’m 78 and I’ve had prostate cancer for 16 years. I’ve lived this long because I’ve stayed on the drugs, While they can be a pain, they are beneficial.

You could get a decipher test, which would tell you the likelihood of having a reoccurrence. If it comes up with a low number, then you probably don’t need to go on longer than six months of ADT.

@jeffmarc, thanks so much for your comment. I do have an appointment coming up with the urologist so I will ask him those questions. I just had the appointment with the radio-oncologist and that was his comment... that I wouldn't need it.

Hey @jeffmarc
"With a 3+4 they usually don’t recommend any ADT."
Would they usually recommend ADT for 4+3?

The lab test results should help indicate how to proceed
PSA, Testerone, PET scan, genetic tests. and how you feel.

@web265
In my case they didn’t, after surgery. I was a 3+4 before surgery and a 4+3 after. I went 3 1/2 years after surgery before my PSA started rising. Pretty sure ADT would not have been given to me that long if they did recommend it.

Below guidelines, highlight the fact that in your case, you would need two of these three things before ADT would be recommended. PSA 10-20, GG2 or 3, T2b-c. So, where do you fit Based on your past history?

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)

@jeffmarc
My PSA was 18 before the surgery, gleason was 3+4 so that would be GG2, the only thing I am not sure of is the T2b-c, the cancer was contained in one area of the prostate but after removal and PET scan, it showed up in the area of the removal, so some had escaped the gland. All clear after radiation and my PSA has maintained a .006 score.

@ronjc
Your PSA is the lowest of the number you will get out of some machine machines. Great results.

You do hit two of the three options which is grade group 2 and between 10 and 20. As a result, six months of ADT is recommended. Since it already got out of the prostate, you would probably be a T3 at least.

If you look at your biopsy results carefully, you will see the T number listed. It was probably T2a or T2b.

@jeffmarc

PSA 10-20 (check)
GG3 (check)
pT2c,pNO

So, as I understand it, (much less than you do), On that scale, I'd be between 6 and 12 mos somewhere.
Thanks for gettin' back. Was just curious.

Well...

Your radiologist is not wrong.

Is your urologist right? I am not sure.

Generally, lower risk cases may do six months ADT when combining with radiation.

The length of systemic therapy can range from 6-36 months if doing fur a defined period.

In the Embark trial if men achieved undetectable in thirst seven months they came off treatment and actively monitored.

I believe in the SPORT trial systemic therapy was six months.

My radiologist says in the tumor review boards the oncologists are all over the map in which ADT, whether to include an ARI, when, what, for how long, criteria for their recommendation on duration, criteria for coming off treatment...

As you can see from the responses on this forum, there is no single course of action that dominates the thread.

When I did triplet therapy starting in Jan 17, original plan was 24?months. Dr. Kwon discussed adding an ARI but wanted to wait to see how I responded to the Lupron and Taxotere. Based on my response he decided to hold on the ARI. He also supported stopping Lupron at 18 months.

When I did doublet therapy in April 24 my going in position was SBRT and six months Orgovyx. My radiologist supported that. My oncologist was ok with the SBRT but wanted to do 24 months ADT + ARI.

He was citing the EMBARK trial, I was thinking the SPORT trial.

So, we decided on the SBRT, 12 months of Orgovyx, hold the ARI, add only if PSA did not drop to undetectable in the first three months and decide at 12 months whether to come off treatment or continue.

We met at 12 months and agreed to come off treatment.

Would having done 24 months in either situation made a difference in the progression free survival time? We'll never know will we!

What we do know is T recovered, the side effects went away, I fret pretty damn good....as an example, when I started doublet therapy my weight was 191, it climbed to 209. Today I am at 185.

Some have issues with financial toxicity associated with their treatment. Others really do feel like crap and the side effects impacts their lives. Some, well, probably a lot, are trying to push back the onset of castrate resistance.

What would I do were I you, knowing what I know now after 12 years of this?

I would listen to the rationale my urologist has.

I would see if there was middle ground where you could meet the urologist part of the way and then decide at that point.

I would discuss what clinical data would constitute reasons to add an ARI or to come off treatment.

As I said, there may not be a single, definitive, "right" decision. There are good choices...

Kevin

I have been on hormone therapy for 4 years. Psa was up to 40 when I started. Doc put me.on Eligard 6 month injections and 160mgs of Xtandi. In 2 months my psa was down to and remains at >0.1. Side effects hit hard. Hot flashes still remain. Took Gabapentin for hot flashes and ended up with neuropathy. Also voiding issues from radiation issues from my first bout with PC 12 years ago. PC returned 4 years ago as stage 4 non-currable and metastisized in my rib cage. My psa still remains at < 0.1. The Dr stopped my Eligard aftet 1 shot and the Xtandi dose 6 months ago from 160mgs to 80mgs because of the low psa and testosterone. Still have significant hot flashes, urination issues and other side effects. Any suggestions on getting rid of hot flashes and neuropathy. Thanks. Dave