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← Return to ADT injection: Benefits worth the toll it will take on my body?
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ADT injection: Benefits worth the toll it will take on my body?
Prostate Cancer | Last Active: May 20 1:57pm | Replies (73)Comment receiving replies
@wwsmith Really hit the high points.
NCCN who sets the guidelines doesn’t call for 3+4 to have ADT unless there are other issues
Here are the guidelines, ask your doctor why he thinks ADT would be right for you since NCCN does not call for it.
NCCN Guidelines
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)
Replies to "@wwsmith Really hit the high points. NCCN who sets the guidelines doesn’t call for 3+4 to..."
I agree with your comments and think they are accurate but how do you marry these guidelines with several new studies, including Duke Health's AI study, that indicate that normal testosterone levels are best for aggressive cancer. When I raised this issue with my urologist, he basically said that there is not yet enough data to change the ADT treatments that have been used successfully for 20 years. My horrible side effects with Lupron which forced me to stop ADT treatment make me eager to find further treatments without ADT if needed in the future.
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@jeffmarc When I first began studying prostate cancer, I would read about following the SOC (standard of care). I had always thought the SOC was some kind of unwritten typical treatment protocol for certain conditions. But now, if I am thinking correctly on this, following the SOC actually means following the most current NCCN Guidelines, right? And if that is correct, I am going to start mentioning that more in posts to new patients and even provide the link for the NCCN Guidelines https://www.nccn.org/guidelines/guidelines-detail
Like you have been doing, I think it is important for all patients to know what the Guidelines say for their condition so that they can compare what their doctors are recommending against the Guidelines. Deviations from the Guidelines are certainly ok if the doctors can make a good case for those deviations. But patients should always be involved in the process and be prepared to question and give their own input towards what is the best treatment for their particular case.