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Radiation + ADT

Posted by tomt4626 @tomt4626, Feb 4, 2024

Like many of you, I am weighing my options regarding surgery vs radiation. 61yo, healthy and active guy. PSA 5.5, MRI negative for any spread outside the prostate, 12 core biopsy with 2 cores 3+3, 1 core 3+4 and one core 4+3. All positive cores were confined to the left part of the gland.

We've had 2 surgical consults and last week met with a Radiation Oncologist. The docs are from 2 major cancer centers. Both surgeons felt that I would have a good outcome but to my age and overall good heath and weight. Surgery and the possible complications still scare the heck out of me......maybe too much reading of internet forums!

Radiation I thought would be more appealing but the RO brought up some points that have me worrying and I would like some input on. My main concern is the use of ADT along with the radiation. He said the standard is 6 mo of ADT and that it would take an additional 6 months for me to get feeling back to myself afterwards. How bad is the shorter term ADT? I am fit, active and working full time and if I am going to feel like crap, lose muscle mass and basically be in a funk for a year, I'm not sure I can handle that. The other issue he brought up that I hadn't really seen talked about is that if you have preexisting urinary issues with urgency, weak stream, etc that radiation will make those issues worse in the short term and potentially in the longterm. I'm on Flowmax now and it does help, but apparently due to the anatomy of my prostate, I am predisposed to having those urinary issues. He said that the urinary issues are greater for the 5 treatment radiation vs the 30 treatment due to the dosages.

I will say I love the idea of the Tulsa Pro, but I don't know that it is appropriate for 4+3 disease. The docs that I mentioned it to are saying they just don't have the longterm studies on it yet, but does that mean you aren't going to recommend new technology without 15 years of data? We would never advance anything if that were the case! I also understand that it is cancer we are dealing with here and we really don't want to mess around.

Thanks in advance for sharing your experiences and giving me some input. Very hard decisions to make as you all know.

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juanmoczo | @juanmoczo | Jan 20 11:28am

In my case, back in October 2023, at 68 y/o, I faced a Gleason 7 (4+3) and PSA @ 20 at the start of treatment. I chose radiation (44 sessions) + ADT (18 months Eligard) over surgery. For me, the ensuing urinary incontinence after surgery was a major issue. Eventually, all cancer patients will face urinary incontinence as we age, but I wasn't ready for it. Presently, my PSA is checked every 6 months, and it is < 01. The ADT was finished in June 2025, and in December 2025, my testosterone level tested 73 ng/dL, certainly better than the required 50 ng/dL that ADT aims for, but far away from the 200 ng/dL minimum that I will reach around May 2026. I still get occasional hot flashes, and I am regaining my muscle strength. ADT is not for the faint of heart. It weakens your body, depresses your mind, and accelerates the aging process. The only antidote for the side effects of ADT is regular exercise, including weight training. Good luck with your choice.

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wwsmith | @wwsmith | Jan 20 2:10pm
In reply to @jesse65 "@toolbelt and to michaelcharles, thanks for that discussion. I'm starting on Orgovyx next week, then 28..." + (show)
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@toolbelt and to michaelcharles, thanks for that discussion. I'm starting on Orgovyx next week, then 28 days of IMRT the following week. After doing Antera AI testing I thought I was in the clear for no ADT. I had multiple consultations where I always asked the docs if they trusted the AI part of AnterraAI, and all said sure, why not. The RT Team I decided to go with said they didn't trust just AnteraAI alone and wanted to add Decipher testing just to make sure. It was a shock to me that Decipher pointed out I have a more aggressive form of Pc than my staging indicted and thus the last minute added need for ADT. Quick research, and the shared experiences of this discussion board, have moved me to choose Ogovyx over Lupron injections. For all the same reasons that you have stated. Reportedly fewer or at least less intense side effects, knowing that I can stop that treatment if it is overwhelming, and at least the illusion that I have some daily control. In reality, I will do just as the doctor orders, the alternative is what I'm trying to avoid at all costs. Best wishes for success to you two and all the members of the club on this discussion board. Invaluable.

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@jesse65 I too had both the Decipher and Artera-ai test. In my case they essentially agreed with a 0.81 Decipher and a true on Artera-ai. But the main point of doing both is for the situation you are in where one test might override the other and you would go with the conservative result. I was only a 3+4 so ADT was in question initially, but I ended up with one year of Lupron. Sure wish I had done Orgovyx so my testosterone would have come back faster. But for a 4+3 case like yours, only a false on Artera-ai and a low Decipher score together would have justified no ADT. See my bio for more details.

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