Weighing the cancer risk reduction & quality-of-life cost of ADT?

@grandpun Did you take any ADT "optimizers" with your Lupron shots? Like Zytiga, Nubeqa, or old school Casodex?

@grandpun Did you take any ADT "optimizers" with your Lupron shots? Like Zytiga, Nubeqa, or old school Casodex?

15 months ago I had 20 rounds of radiation for the prostate and prostate bed, and about 3 months or more before that, I was put on an ADT regime using Lupron.
I have an appointment with my Radiation Oncologist next week follwing the last blood analysis which has indicated a rise in my PSA from .001 to .003. Unfortunately, I have been a bit timid (and unprepared) at appointments with my Urology Oncologist, who indicated the recent change while also mentioning a rise in testosterone. I can see the effects of that increase in my penis and scrotum. This clearly looks like resistance has set in.
I hope not to have to have more radiotherapy, and that a new ADT treatment option is available. We shall see.
If anyone has experienced this I would welcome hearing your story.
As for the side effects of ADT itself, I have found it to be challenging but manageable. It's manageable because I'm retired and can get out of bed when I'm ready. [Yes, fatigue has been a side effect that limits my physical activity. ] The hot flashes seem to vary from day to day, and I'm now trying to figure out whether my sugar and/or salt intake makes them more frequent. Thanks

@dksweet
No add-ons. Just Lupron every 3 months. that seemed to be enough.

@dksweet
Something to be aware of when being on ADT. Being on ADT alone can cause you to become castrate resistant. It happened to me after 2.5 years of being on ADT.

If you are put on a drug like Zytiga or Nubeq that can greatly extend the amount of time before you become castrate resistant.

Being castrate resistant can make it more difficult to treat your cancer and can reduce the amount of time drugs work.

In response to Soli's post of Nov 25, I recall watching a presentation on Youtube in which they discussed the benefits of ADT, and one of the graphs really stuck with me. It showed that ADT resulted in an average length of life by about 13%. Didn't seem like much of a trade off to me considering the potential side effects, but everyone's situation is different of course.

I am interested in the discussion here about NNT, number needed to treat. As I tried to get an understanding of this, I saw that there is also NNH, number needed to harm. Clinicians get enthusiastic about a treatment if there is a low number needed to treat combined with a high number needed to harm.

I don't claim to have a good understanding of how, exactly, to apply info like NNT to my decision as to whether to accept ADT or not.

Any time my RO answered my question as to what is the benefit for me from his prescription of 2 years of ADT he says 20%. I believe he means doing the 2 years improves my possibility of survival over some time period by 20 points. I have always viewed his answer somewhat skeptically. There is more to it. I don't assume he is wrong though. I believe I did not and so far do not understand enough to knowledgeably discuss this with him. That hasn't stopped me from bringing the subject up once in a while.

As Kishan himself says in the video the OP soli recommended: "we hope to get to a time one day where we can really confidently tell someone if they need hormone therapy or not".

As Jeff Marchi put it, "it stops your metastasis from growing and keeps any cancer from starting to grow... [so] ...it benefits everyone". Exception: ADT doesn't work in this way in up to 20% of PCa patients. And it only works in the other 80% until it doesn't. But when it works, its incredible.

I've been taking Orgovyx for a bit more than 2 months and my PSA has dropped from 7 to 2. My RO confirms this means its working for me. I am therefore an enthusiastic supporter of 2 months of Orgovyx. The side effects I've experienced are tolerable, and the benefit of feeling like my cT3b cancer is experiencing a major setback is a great feeling.

I took a look at the Kishan video: I note that Kishan starts out by describing two basic types of RT, external and internal, but then says he limits this talk to external. I found that odd the first time I saw this video some weeks ago, and even more odd as I see someone refer to this video as one of their premiere sources for their opinion of ADT.

The thing about internal RT, i.e. brachytherapy, is the dramatic effect it appears to have on reducing the time anyone would prescribe ADT for. Evidence is continuing to accumulate that external beam of any type combined with brachytherapy boost results in an improved recurrence free survival time and allows less time on ADT.

The TRIP trial showed that high risk patients given EBRT plus BT boost and 30 months of ADT had no measurable outcome that was different than patients given EBRT plus BT boost and 12 months of ADT.

Of course, if a patient has already had their prostate removed, a BT boost is out of the question. For those reading this who still have their prostate, search on "How Much is Enough? with Dr. Nelson N. Stone, MD" to hear Dr. Stone's view. Look up the TRIP study to see its conclusion.

My medical oncologist pointed out that the TRIP criteria only considered high risk patients up to pT3a, not cT3b as my case is, but he expressed interest in what my RO would say. Once I asked my RO about TRIP he reconsidered his external beam only plus 2 year prescription of ADT and scheduled an appointment to more fully evaluate my eligibility for a BT boost.

My RO is chief of the BT program at his institute, but he had initially told me it looked like I would not be eligible for a BT boost due to gland size and LUTS. My enthusiasm for a longer recurrence free survival time and less time on ADT appeared to play a role in his decision to reconsider.