MRI Results

@ebooneac With a 4+3, I had similar treatment - 28 sessions of proton radiation (2.5 Grays per session), with SpaceOAR Vue injected. Also, on Medicare + Supplement.

What did they advise you regarding declining hormone therapy for a 4+3?

@ebooneac
Why are you "declining hormones"

@brianjarvis I asked the R/O if he would treat me if I refused ADT, he said yes. My reason in another reply:
@soli During my recent 02/04 visit to the Emory Proton Beam Center, the R/O gave to me the same 70% and 5% numbers. Along with many of the stories of quality of life degradation of ADT, I also see that a side effect is blood clots. I have a history of pulmonary embolism, which is another reason at this time my decision is to forgo ADT treatment.

@toolbelt

@soli During my recent 02/04 visit to the Emory Proton Beam Center, the R/O gave to me the same 70% and 5% numbers. Along with many of the stories of quality of life degradation of ADT, I also see that a side effect is blood clots. I have a history of pulmonary embolism, which is another reason at this time my decision is to forgo ADT treatment.

@brianjarvis To me its a tradeoff between a 5% increase of cure vs the side effects of hormone medication. If I begin the slope of loosing muscle mass and stamina, depression will follow. Include the PE risk to that.

@ebooneac
A history of pulmonary embolism while not a contraindication for ADT is a significant risk factor.
As to QOL I can only speak to my experience with 6 months of Orgovyx, with that experience being it was entirely tolerable. I watched my diet and exercised......a lot...... I had some muscle aches, hot flashes that were no big deal, no brain fog or depression. I believe with a vigorous exercise program you can alleviate a lot of the stamina and muscle loss side effects.

Stay Strong Brother, We Got This

@ebooneac My medical oncologist game me a heads-up of what to expect and how to minimize/avoid those risks (well before my first shot).

Since then, I’ve found much information on this topic. Here are just a few that I’ve bookmarked:

> Drs. Sholz and Moyad talking about exercise and hormone therapy: https://m.youtube.com/watch

> A paper on The Benefits of Exercise During Hormone Therapy: https://static1.squarespace.com/static/54c68ac6e4b06d2e36a4b8c9/t/55cb7275e4b0d97ae7ff60af/1439396469154/The+Benefits+of+Exercise+During+Hormone+Therapy_Insights+August+2015_PCRI.pdf

> A study about the benefits of exercise to counteract the adverse effects of ADT: (They describe a good resistance-training program): https://journals.lww.com/acsm-msse/fulltext/2023/04000/resistance_exercise_training_increases_muscle_mass.2.aspx

Mental health benefits of exercise while on ADT: https://m.youtube.com/watch

Side-effects of ADT: https://m.youtube.com/watch

Resistance-training
> https://pcri.org/sky-2/2017/9/19/fitness-and-longevity-rylt4

For me, I did lose muscle mass (and strength), but I did maintain some lean muscle mass; I did experience zero libido (but everything worked); and I had “warm” flashes. All in all, by choosing to ramp up my exercise regimen, I didn’t have much problem with hormone therapy.

With hormone therapy, if you do what it takes, you would do very well with the hormone therapy - it’ll just be an annoyance; if you don’t do anything, hormone therapy can be your worst nightmare.

@ebooneac Do you already take a blood thinner? If so, combined with exercise you’ll probably be OK. Orgovyx is what you’d want, since it is oral and you can discontinue if necessary (not injectable Lupron).
6 mos ADT is certainly preferable to a lifetime of it if your cancer returns after radiation therapy….Gleason 4+3 unfavorable is ‘this close’ to an aggressive case.
Phil

@ebooneac
You could instead use the estradiol patch. The patch studies showed it’s just as effective as ADT, but has many fewer side effects.

Another option would be to get on Nubeqa. I know many people that are on it as their only drug. I was on it for eight months without ADT and my PSA still stayed undetectable. Something to discuss with your doctor. This drug keeps the prostate cancer from growing and spreading, even if you have testosterone. I’ve been on it for almost 3 years and I’ve been undetectable for the last 27 months.

@capatov

Similar situation as you with negative MRI. What was your PSA? I am surprised that you were able to get a biopsy on free pSA test results. Its good you did obviously. My PSA was around 2 and with negative MRi , I had to offer to pay to get a biopsy here in San Diego.