ADT: How long until I can expect the hot flushes to kick in?

1. I am an outlier.
2. I took only 2 shots of Lupron in 2022 and stopped.
3. I had only 1 side effect: lack of testosterone deprived me of my muscle mass.
4. This is 2025.
5. It still has not returned enough for me to walk safely on the sidewalk.
6. I am now 88 years old.

@jimbo12

I was 82 when I started photon radiation and Lupron for Stage 3tb prostate cancer. The radiation was tough with frequent diarrhea and tenesmus pain for 4 hours/day. I struggled to finish 44 treatments and kept up my exercise regime.

Lupron was even worse with 24/7 soaking sweats, severe headaches, hourly urination, muscle cramps, and joint and muscle pain. Had to try to sleep with no covers to allow sweat to evaporate. I am cold all the time. I had to quit after 4 months on Lupron, or I believe I would have died. Tests 1 month and 4 months after treatment stopped had PSA < 0.1 and testosterone < 9. Now after 5 months I have all the same symptoms, but they are becoming less severe. Still absolutely no libido or erections. My privates have shrunk about 50% and when I tried a penis vacuum pump, I got bleeding around the scars of my circumcision plus pain. I feel 10 years older than I did one year ago but I still exercise pretty hard for an hour most days.

@pesquallie Wow! That was rough. My oldest brother is 79y and just finished 28 sessions of photon radiation in Sept. He experienced none of those side-effects.
> did you use a rectal spacer and do the full bladder/empty rectum routine consistently?

He’ll be on Eligard for a couple of years and hasn’t had any awful side-effects. He had a PSA test 2 weeks ago; it was 0.004. (So, we know the Eligard is working like it’s supposed to.)

How long were you on Lupron? They say that side-effects will linger for 50% additional months than it was planned for. And the older you are reduces the probability of testosterone levels returning to what it was.

Just keep pressing forward.

@brianjarvis

I was only on Lupron for 4 months and it was killing me, so I had to quit. I had no rectal spacers. Wish I knew what I know now and i would have asked for more and better treatment.

@brianjarvis
I was on ADT for seven years when I stopped taking it because I figured my Testosterone would never come back and so did my oncologist. After seven months, my Testosterone hit 50 was going up 25% a month and my oncologist said I should go back on. I was 77.

It can come back a lot quicker, You just never know how long it will take.

I was on Lupron for the first six years and Orgovyx for about nine months before I stopped taking it.

ADT side effects and length of duration (ADT history below - you can skip to the bottom line if you want):
RALP January 2022.
Started Lupron March 2022.
Side effects: muscle loss, fatigue, hot flashes, some body hair loss.
Ended Lupron January 2024.
But some hot flashes still continue. Less intense, less frequent.
Had Prolia during and one year after Lupron - last shot June 2024.
All the time took calcium for bones and still do.
September 2025 started having chronic back pain. Thought it was muscle spasms.
Pain got worse until I had debilitating, shooting pains up my back.
Found out Dec 4, 2025 I had 3 compression fractured vertebrae.
Had an operation procedure called Kyphoplasty. It restored the bone strength and some bone height. No pain afterwards. Thank you Lord!!!!

Bottom line: watch and MAINTAIN your bone (and muscle) health and integrity every way you can.
Good luck to you on ADT. Fight the SE's all the way AND beyond!!!!!

@jeffmarc These are things I’m still learning more and more about. It seems that length of time (and one’s age) on ADT not only risks T never coming back, but also of prostate cancer cells becoming hormone-resistant, of the prostate cancers finding an alternative food source, or even adapting to make their own T.

I had two 3-month injections of Eligard; T went as low as 3.0 ng/dL; 6 months after the 2nd injection, T was at 403 ng/dL and eventually returned to baseline.

Discussions like this have led me to look for data that supports less ADT use.
Here is a video: "Radiation Dose and Hormone Therapy: How Much is Enough? with Dr. Nelson N. Stone, MD"

He says he will explain why this needs to change in this talk.

Around minute 13 of the video he discusses the TRIP study, which took place in Japan.

This study gave each member of a group of high risk prostate cancer patients the same carefully measured total dose of combination external beam and brachy radiation therapy, then divided them into two groups.

One group got 6 months of ADT, and the other group got 30 months. The patients were followed for a median time of about 9 years.

The result was that there was no statistically significant difference in any measurable outcomes whether the patients got 6 months or 30 months of ADT.

He concludes that this study suggests that the most important factor influencing freedom from progression of prostate cancer after RT is if the total delivered radiation dose is high enough.

And if the total delivered radiation dose is high enough, there is a reduced need for ADT, i.e. 6 months is enough.

The total dose of radiation that all patients received in this study can only be delivered safely with a combination of external beam and brachytherapy.

@climateguy
interesting study. I’ve heard the combination of IMRT/EBRT and brachytherapy is really the ideal for advanced prostate cancer. I’ve heard of a number of people getting it, but never seen a study (now the Trip study) that showed that it was the optimal way to do it. Interesting thing is the study did brachytherapy first and EBRT second, Something I’ve never heard of anybody having. It’s always been the other way around.

I wonder if it would make a difference.

The study didn’t seem to take into account, very advanced cases, however. The criteria was T2c-3a, or a prostate-specific antigen (PSA) >20 ng/ml or a Gleason score >7.

Why didn’t they include T3b it T4?

I sure would be interested in seeing the results of a trial that worked with more advanced cases. These were just somewhat advanced.

@jeffmarc Dr. Stone claims in the talk that he controlled when the brachytherapy was administered for all the centers in the TRIP study. He taught or advised all the participating centers in Japan on how to administer BT. But he didn't set up the study. The Japanese researchers apparently are the ones that decided T3a.

Keep in mind that he has been a pioneer in figuring out the way to compare different RT treatments, i.e. this Biologically Effective Dose concept, or BED he talks about. So he had seen that most BT studies were not publishing their actual delivered dose figures, rather, they published the dose they planned to administer. He was emphatic saying BT practitioners all know that the planned dose doesn't always get achieved. He felt that the external beam people were going to be able to deliver what they planned more than the BT people, so he had the BT people administer their planned dose, then calculate what they actually delivered, then he had the EBRT people administer more or less of what they planned so the BED of all study participants would be as nearly the same as possible. He feels this is a weakness of the Ascende-RT trial, i.e. more total dose than planned because of inexperienced practitioners, which resulted in the high number of grade 3 complications they reported, giving BT a bad name.

Dr. Stone is about as eminent in the BT and RO field as they come, so I don't think this BT first approach is anything that controversial.

I am very interested in getting EBRT with a BT boost. I am c3Tb. My RO says he runs the BT at the NCI facility he works at, and that I am not a candidate because of a 62 cc prostate and a too high IPSS score.

So I'm tracking down research that indicates there is no problem with larger prostates and BT. I found a European document that states they changed their previous limit and now allow much larger prostates due to new research published by Dr. Stone among others.

I'm looking for studies that allow BT on patients who have had recent corrective "outlet" therapy. It appears that in Europe, I would be a candidate for EBRT + BT boost. I like the RO who says I'm not a candidate, but if I can't convince him I will probably be looking for a clinical study or a practitioner who will consider my case more favorably.

If I find a study of >pT3b I'll let you know. Dr. John Sylvester, another proponent of BT, said in a talk I've been studying that high risk cases benefit the most from BT.