Hormone therapy before radiation treatment question....

@ecurb
While you suffer from fatigue, be careful about how much sleeping you do in the afternoon. I occasionally get tired in the afternoon, I take a 25 minute nap setting my phone for 25 minutes. That keeps me awake till midnight.

The problem is, if you sleep more than about an hour, you go into REM sleep. Once that happens it makes it more difficult to sleep at night. People find they’re not getting a full nights sleep when they do that, and as a result, they are tired in the afternoon. The short naps resolve that issue and allows you to get a full night’s sleep.

If he wants you to take a daily ADT, then he probably is going to give you Orgovyx, The only ADT you get daily. Orgovyx For ADT Allows the testosterone to come back much quicker, which will minimize the side effects.

While you will have some effects from the ADT. They should be very short term. Muscle loss bone deterioration are all things that happen over time not enough matter of a couple of months. You could do some weight exercises to keep the muscles you have in shape.

Whether or not you gain weight is up to you most of the time. Weigh yourself on the scale daily and eat based on what you weigh. I’ve never gained weight and I’ve been an ADT for eight years.

You may get hot flashes. If you do, there are some resolutions, Come back and ask if you have a problem with them.

3 1/2 years after my surgery, my PSA started rising, so I had salvage radiation. They gave me a six month Lupron shot two months before the radiation. To tell you the truth, I didn’t really have any side effects at all from it. He’ll be much better off with Orgovyx.

Recent studies I’ve shown it’s more effective to have ADT at the time of radiation Or shortly after it rather than Before radiation. Here’s some information about that you could talk to your doctor about. This is pretty new information and doctors are not really doing it yet.
https://www.medscape.com/viewarticle/940049
Some information on radiation treatment, if you’re cancer comes back.
People who have radiation as their primary treatment have been told by doctors that surgery isn’t really an option if there’s a reoccurrence. Other options are not really mentioned..

This study shows that both salvage focal therapy (HIFU and cryotherapy) and salvage surgery were equally effective at extending the life of a patient that started off with radiation.

Those that had focal therapy had fewer perioperative complications.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2844900
.

You will probably continue ADT for 6-8 weeks after radiation as well; it’s usually a 6 month total, but 4 is also done.
Keep exercising -especially when you don’t feel like it! Pushing thru the fatigue is KEY for success.
Also, get your body used to low fiber meals - gas in the bowels is a big no no! The Linac machine is great when it comes to thus because it automatically turns off if a gas bubble moves your prostate out of target range; but your RO won’t be happy if the 15 minute procedure becomes an hour or more because of gas issues. Do some diet homework! Best,
Phil

@climateguy Hi there - I'm just reflecting on your statement "ADT versus no ADT does not improve patient outlook by that much". Apparently it depends heavily on the risk group and the stage of the prostate cancer being treated.
While androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer treatment, research shows its benefit varies significantly:
Low-Risk Disease: The statement is True. ADT provides little to no survival benefit for low-risk, localized prostate cancer and is generally not recommended as a first-line treatment.
High-Risk/Locally Advanced Disease: The statement is False. Adding ADT to radiation therapy (RT) for high-risk, localized, or locally advanced disease (T3/4) shows significant improvement in both disease-specific and overall survival.
Metastatic Disease: The statement is generally False, but nuanced. ADT is standard care, but modern treatment involves adding newer agents (ARPIs) to ADT to significantly improve survival over ADT alone

@stew80 I wrote: "Exercise reduced the risk of cancer recurrence or death by 28%. ADT vrs no ADT does not improve patient outlook by that much."

I meant ADT does not improve patient outlook compared to no ADT, by as much as the 28% improvement found in the CHALLENGE study I was discussing. I didn't mean to imply that ADT was not a first line treatment.

I was thinking about my specific case, which has been summed up by my radiation oncologist as "cT3b". He also describes me as "at least high risk" although he has no evidence that it has metastasized except to the seminal vesicles. He has a senior position at an NCI designated cancer facility, and when I asked how much of a benefit I can expect if I accept his prescription for 2 years of ADT, he said 20%.

I realize that the benefit of ADT varies according to the stage of cancer that is being treated. However I agree with those who say now that evidence such as the CHALLENGE trial exists, it is time for the doctors and patients to change their attitudes to the benefits of exercise, from the current "it can't hurt", or it seems like a "good idea", to something as valuable in cancer care as things like ADT or chemo, i.e. first line recommended treatment, with recommendations and supervision paid for by insurance.

@jeffmarc

Thank you so much for the information and links....I am so glad I found this group.....Everyone has been very helpful, and I am learning by everyone's responses, and comments throughout this board....

I received an update from NYU today as well....They sent my biopsy slides to a company in Florida (Artera) which does an AI assessment of the biopsy slide...My prognostic risk score was "low"...And the document mentioned "no clear risk reduction with the addition of short-term androgen deprivation therapy to RT"...

The great staff at NYU believes with my advance PC, I should still follow through with the short term ADT. It's because the pathologist noticed cribriform when they reviewed the slides....I am waiting for the Decipher results which won't be ready for 4-5 days....

The nurse practitioner did mention to me that the ADT treatments will be for 4-6 months, and not 4-6 weeks.....I guess I misunderstood when I met with the RO at NYU....either way I am preparing myself mentally and physically for the journey ahead....

I really appreciate all the guidance and support from ya all.....

You all are in my prayers!

Thank you!!

Exercise seems to be a tremendous help in getting through ADT. I started relugolix about 4 weeks before SBRT and am ending it after 6 months. During the 6 months I kept up my exercise routine - walking several miles 4-5 times a week, some light weight work, stretching - and at 80 I felt fine once the SEs from the radiation cleared. I've had mild hot flashes which have been annoying but not an interruption to my daily routine.

I have one question about the study mentioned above about the advantage of beginning ADT when radiation starts rather than weeks before. The study is from 2020 which precedes some of the advances in radiation treatment - MRI Linac and adaptive CT monitoring. My RO and my urologist independently told me that weakening the pc prior to treatment would make the radiation more effective. That sounds like an advantage that would be lost if ADT started at the time treatment began.

Thanks for clarifying. I was also diagnosed as T3b and my doctor encouraged
me to remain on ADT for 2 years *after* my PSA first became
undetectable. That put me into the summer of 2027. I asked about taking an
ADT holiday (pausing for a few months and then starting again). He said he
didn't like that idea. I thought the benefit might be higher than 20%. I
truly would love to get off the ADT, but ......