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

Posted by soli @soli, Nov 7, 2025

My first post-prostatectomy PSA test this week came at < .02 as expected. I will meet with my urologist next week. Given my high risk profile (T3b stage+ SVI+ Decipher score of .75) I expect my urologist to propose adjuvant radiation treatment of the prostate bed plus ADT. I have been thinking a lot about this and I would definitley agree with the adjuvant radiation treatment, but I am not yet convinced that the incremental cancer control benefits of ADT outweigh its potential harms (metabolic, cardiovascular, bone health etc) . I am weighing this in the context of my value system at my age (in the 70's): moving forward, quality of life is much more important to me than the absolute length of life. To put it differently - if say given the following two options : 7 or 10 more years with quality of life vs 15 or more years with debilitating side effects that diminish my quality of life - I would choose the former.

How did folks in similar situations weigh the potential incremental cancer contral costs of ADT vs its potential harmful side effects? Are you happy with your decision or is there anything that you regret? How bad and long lasting are the side effects of ADT?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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tango32652 | @tango32652 | Feb 12 1:04pm
In reply to @jeffmarc "@tango32652 At the monthly Mayo conference yesterday They showed a real interesting PSMA pet comparison of..." + (show)
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@tango32652
At the monthly Mayo conference yesterday They showed a real interesting PSMA pet comparison of before and after being on ADT with a person with a number of metastasis. How much it reduced the metastasis is pretty eye-opening.

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@jeffmarc Eye opening indeed. I think that 13% life extension they talked about not only incluced what you're showing here, but they also factored in eventual castration resisistence to come up with an average length of lifespan. Thing is, no one is "average". The bell curve on this must be huge.

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pesquallie | @pesquallie | Feb 13 1:41pm
In reply to @soli "@climateguy If and when I experience BCR, the trade-off between the side-effect burden of ADT and..." + (show)
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@climateguy

If and when I experience BCR, the trade-off between the side-effect burden of ADT and its potential curative benefit will be a major concern for me. In one of his videos, Dr. Kishan—whom I consulted a few weeks ago about his clinical trials—states that ADT improves BCR-free survival from 82% to 85%. In the same video, he also says that for every 8 people treated, 1 benefits.

I understand this to mean that if I undergo ADT, I have only about a 12.5% chance of a very modest improvement in outcomes (an increase from 82% to 85%), but a near-100% chance of experiencing side effects that many people find debilitating. I did briefly raise this concern with both Dr. Kishan and his physiian assistant, but we did not discuss it in detail since I had so many other questions for them, including whether I will be good candidate for MRI-guided SBRT given my pre-existing urinary issues: that is if and when I experience BCR.

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@soli

Great comment and several new studies show that ADT treatment only helps a relatively small number of men, but almost all men suffer severe side effects. My side effects were the worst I have read about, and I believe a third dose going beyond 4 months would have killed me. Duke, Harvard and Swedish studies seriously question the effectiveness and safety of taking ADT. They hope to be able to determine how to identify the men that will benefit and restrict ADT to those men only.

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Jeff Marchi | @jeffmarc | Feb 13 5:00pm
In reply to @pesquallie "@soli Great comment and several new studies show that ADT treatment only helps a relatively small..." + (show)
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@soli

Great comment and several new studies show that ADT treatment only helps a relatively small number of men, but almost all men suffer severe side effects. My side effects were the worst I have read about, and I believe a third dose going beyond 4 months would have killed me. Duke, Harvard and Swedish studies seriously question the effectiveness and safety of taking ADT. They hope to be able to determine how to identify the men that will benefit and restrict ADT to those men only.

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@pesquallie
Not sure you saw this. At The Mayo Clinic monthly meeting this week they showed this slide of somebody who only had ADT. Check out the improvement in metastasis.
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