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Should I add ADT to Salvage Radiation at age 76?

Posted by jablakely @jablakely, Mar 13 11:54am

I just turned 76 years old. My prostate was removed 15 years ago (Gleason was 3+4, grade 2) and I had no trouble until my PSA went from 0.3 to 0.7 in the last 18 months. A Pet scan now shows activity limited to the prostate bed only. My urologist and RO recommend 40 sessions of SRT plus 6 months of ADT. I am considering SRT only.

I am a very vigorous 76: before the pet scan results I booked a week long hiking trip for September in a part of the world I love. From what I see of the statistical benefits of adding ADT, it doesn't seem worth spending my 76th year (and perhaps beyond) suffering the fatigue and other ADT side effects. I am seeing something like a 10-15% better chance of avoiding recurrence with ADT, a 3-6% better chance of avoiding metastasis but at my age, virtually no overall survival benefit.

How would I feel if I refused ADT now and suffered recurrence at age 80 or 85? I suspect I would feel grateful that I thoroughly enjoyed a healthy 76th year.

But the fact that I'm asking for advice on this forum is an indication that I realize the gravity of this decision. Any thoughts, brothers?

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

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wwsmith | @wwsmith | 3 days ago
In reply to @surftohealth88 "@jeffmarc Yes, you remembered well Jeff : ). And yes, my husband will need ADT at..." + (show)
Profile picture for surftohealth88 @surftohealth88

@jeffmarc

Yes, you remembered well Jeff : ).
And yes, my husband will need ADT at least for 6 mos (we were told), regardless of how low PSA is. Even if we decided to have adjuvant immediately post op with uPSA undetectable, my husband was advised to have ADT since he is a high risk patient.

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@surftohealth88 I think those ASCO recommendations about using PSA at the start of salvage radiation as the only factor to determine whether ADT is needed or not need to be further annotated. There are lots of patients like your husband that have adverse factors that justify the use of ADT regardless of what their PSA is at the start of salvage radiation.

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johnny8924 | @johnny8924 | 3 days ago

Perhaps consider going with Orgovyx and see what side effects, if any, occur. You can stop taking Orgovyx if the side effects become problematic. Good luck.

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domiha | @domiha | 2 days ago

Someone else on this forum just shared this with me and I thought you might find it interesting.
Best wishes! ENJOY that hiking trip you have planned!!
Mike
https://ancan.org/playing-the-long-game-does-your-recurrent-advanced-prostate-cancer-need-treating-nci-seminar/

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