Hormone therapy before radiation treatment question....

@stew80 I accepted the idea that I would give staying on ADT for whatever time my RO suggested my best shot regardless of the various bad things I've heard about it.

I.e. I heard a recording of a urologist speaking to an audience of other urologists who said: "ADT wrecks old men's lives. We all know that". I also didn't like the available data that indicates that the longer a patient is on ADT, the less likely it is that their testosterone level will recover to the level it was pre-ADT. And, many patients never recover their testosterone.

However, I came to agree with those who state that ADT drug therapy is about as good of a drug therapy that exists in cancer care, because in so many cases it can set the cancer back significantly for very long periods of time. It also seems to allow radiation to work better. I decided to accept whatever the data showed in the way of ADT length given the particular definitive therapy I eventually chose.

After I decided on radiation as my primary treatment, I looked for if there were radiation treatments that called for less ADT time. There are.

I eventually chose 20 sessions of external beam, plus a high dose brachytherapy boost. The TRIP study examined if there was a difference between groups of men who were all given this same radiation combination therapy. One group were given 6 months of ADT and the other had 30 months.

The study was designed to show the superiority of 30 months of ADT. There was no meaningful difference in any measurable outcome between the two groups of patients.

The TRIP study would not have accepted me as an eligible patient because the cutoff for eligibility was stage T3a, and at T3b my case is too high risk.

However, my RO is now talking about 1 year of ADT rather than 2 years.

Nelson Stone discusses the TRIP study in the video entitled "Radiation Dose and Hormone Therapy: How Much is Enough?". He supervised the criteria for all the centers who administered the radiation treatments for this study to make sure the delivered dose were as uniform as possible no matter what center the patients were treated at. The TRIP discussion is about halfway into the video.

@stew80 I accepted the idea that I would give staying on ADT for whatever time my RO suggested my best shot regardless of the various bad things I've heard about it.

I.e. I heard a recording of a urologist speaking to an audience of other urologists who said: "ADT wrecks old men's lives. We all know that". I also didn't like the available data that indicates that the longer a patient is on ADT, the less likely it is that their testosterone level will recover to the level it was pre-ADT. And, many patients never recover their testosterone.

However, I came to agree with those who state that ADT drug therapy is about as good of a drug therapy that exists in cancer care, because in so many cases it can set the cancer back significantly for very long periods of time. It also seems to allow radiation to work better. I decided to accept whatever the data showed in the way of ADT length given the particular definitive therapy I eventually chose.

After I decided on radiation as my primary treatment, I looked for if there were radiation treatments that called for less ADT time. There are.

I eventually chose 20 sessions of external beam, plus a high dose brachytherapy boost. The TRIP study examined if there was a difference between groups of men who were all given this same radiation combination therapy. One group were given 6 months of ADT and the other had 30 months.

The study was designed to show the superiority of 30 months of ADT. There was no meaningful difference in any measurable outcome between the two groups of patients.

The TRIP study would not have accepted me as an eligible patient because the cutoff for eligibility was stage T3a, and at T3b my case is too high risk.

However, my RO is now talking about 1 year of ADT rather than 2 years.

Nelson Stone discusses the TRIP study in the video entitled "Radiation Dose and Hormone Therapy: How Much is Enough?". He supervised the criteria for all the centers who administered the radiation treatments for this study to make sure the delivered dose were as uniform as possible no matter what center the patients were treated at. The TRIP discussion is about halfway into the video.

@climateguy
“ ADT wrecks old men’s lives .”

I’m 78, I think they would consider that old man. I’m just wondering how it wrecked my life. Nobody could tell I have it looking at me. I’m very active no fatigue to speak of. I do pretty much the same as other people, my age. Been on it for eight years. Jog the track A mile twice a day. Go to the gym three days a week. I don’t know about being wrecked.

After seven years on it, I decided to stop taking it, with my oncologists approval, figuring my testosterone would never come back. In seven months, it rose to 50, it was rising 25% a month. My oncologist wanted me to go back on Orgovyx Because studies have shown having testosterone rise above that can cause the cancer to start growing again.

I do have BRCA2 Which really requires me to keep up my drugs or my PSA can start rising quickly.

@jeffmarc I didn't think any urologist would agree with a statement that "ADT wrecks ALL old men's lives". All the urologists I consulted, when ADT was discussed, assured me that at least many of their patients do OK with it. I don't think that any urologist would agree with a statement that "Every patient does OK on ADT". In the recording of the urologist talking to an audience of urologists who said the line I quoted, i.e. "ADT wrecks old men's lives, we all know that", no one jumped to their feet to say what a load of BS, everyone knows ADT is great. No one. My conclusion was ADT can be very problematic for some men who are on it, and the longer they are on it, the more likely they are to be one of the men who has trouble with it.

Your case is a great example for other patients to hear about, especially patients somewhat new to understanding that they have been diagnosed with Pca. Your positive attitude and your success in living well many years after diagnosis helps anyone who hears about it to believe they might enjoy the same success.

@climateguy
“ ADT wrecks old men’s lives .”

I’m 78, I think they would consider that old man. I’m just wondering how it wrecked my life. Nobody could tell I have it looking at me. I’m very active no fatigue to speak of. I do pretty much the same as other people, my age. Been on it for eight years. Jog the track A mile twice a day. Go to the gym three days a week. I don’t know about being wrecked.

After seven years on it, I decided to stop taking it, with my oncologists approval, figuring my testosterone would never come back. In seven months, it rose to 50, it was rising 25% a month. My oncologist wanted me to go back on Orgovyx Because studies have shown having testosterone rise above that can cause the cancer to start growing again.

I do have BRCA2 Which really requires me to keep up my drugs or my PSA can start rising quickly.

@jeffmarc hello. Firstly, I have to take issue with the doctor who says that your Cancer will come back if you take hormone therapy, I am presuming “TRT!”
TESTOSTERONE REPLACEMENT THERAPY.
That’s just not accurate.
If you currently have detectable cancer cells, “TRT” will feed those cancer cells and it wouldn’t be a good idea. I had been utilizing “TRT” for about 12 years before I was diagnosed with Prostate Cancer. I am basically medically castrated without utilizing “TRT”. My “T” level is between 20-50. I am generally around 750-850 on “TRT,” Without “TRT”
I am basically bedridden and home confined. I have no energy at all. Coupled with serious and debilitating cases of Chronic Fatigue Syndrome and Fibromyalgia for the past 35 years. For your consideration and future research. TESTOSTERONE can’t feed cancer cells that are not there. If the lab report verifies that there is no detectable cancer cells then that’s the best you can do.
Everyman produces Testosterone. If what that doctor is proposing were true, every man would develop Prostate cancer which of course, is not the case. I discontinued my “TRT” a month before my surgery and for 5 months following it. My surgeon and oncologist kept asking me how I was feeling. I told them that I really wouldn’t be able to give them an accurate answer and observation until I started my “TRT”again. After starting my “TRT” for only the first week I was feeling as good as I was before my surgery. Of course, all men are different. Regardless of my Prostatectomy, I require “TRT” just to maintain any kind of normal lifestyle though already measurably reduced because of my “CFS” and “FIBROMYALGIA !”
Due to my long standing “TRT,” I was getting my bloodwork done every 3 months for the 12 years prior to being diagnosed with my prostate cancer. That’s how it was discovered as quickly as it was. All of a sudden my PSA went up from 4 to 6 to 7. I was trending in the wrong direction. The usual tests were done and my biopsy just confirmed it and determined what level I was at.
My PSA was < 0.014 right after my surgery in October of 2022 and has remained the same through today, March of 2026. I still have my blood work and additional bloodwork done every 3 months.

I’ve never heard of any man functioning well in his overall life, wellbeing and energy levels on “ADT.” I already know that I wouldn’t given my particular situation.
PC is a very personal disease that many many men come to experience and manage during their lives.

There is no best solution or treatment that works the best for every man. There is only the treatment that works best for you.
Best wishes and good luck.
GODSPEED

@jeffmarc hello. Firstly, I have to take issue with the doctor who says that your Cancer will come back if you take hormone therapy, I am presuming “TRT!”
TESTOSTERONE REPLACEMENT THERAPY.
That’s just not accurate.
If you currently have detectable cancer cells, “TRT” will feed those cancer cells and it wouldn’t be a good idea. I had been utilizing “TRT” for about 12 years before I was diagnosed with Prostate Cancer. I am basically medically castrated without utilizing “TRT”. My “T” level is between 20-50. I am generally around 750-850 on “TRT,” Without “TRT”
I am basically bedridden and home confined. I have no energy at all. Coupled with serious and debilitating cases of Chronic Fatigue Syndrome and Fibromyalgia for the past 35 years. For your consideration and future research. TESTOSTERONE can’t feed cancer cells that are not there. If the lab report verifies that there is no detectable cancer cells then that’s the best you can do.
Everyman produces Testosterone. If what that doctor is proposing were true, every man would develop Prostate cancer which of course, is not the case. I discontinued my “TRT” a month before my surgery and for 5 months following it. My surgeon and oncologist kept asking me how I was feeling. I told them that I really wouldn’t be able to give them an accurate answer and observation until I started my “TRT”again. After starting my “TRT” for only the first week I was feeling as good as I was before my surgery. Of course, all men are different. Regardless of my Prostatectomy, I require “TRT” just to maintain any kind of normal lifestyle though already measurably reduced because of my “CFS” and “FIBROMYALGIA !”
Due to my long standing “TRT,” I was getting my bloodwork done every 3 months for the 12 years prior to being diagnosed with my prostate cancer. That’s how it was discovered as quickly as it was. All of a sudden my PSA went up from 4 to 6 to 7. I was trending in the wrong direction. The usual tests were done and my biopsy just confirmed it and determined what level I was at.
My PSA was < 0.014 right after my surgery in October of 2022 and has remained the same through today, March of 2026. I still have my blood work and additional bloodwork done every 3 months.

I’ve never heard of any man functioning well in his overall life, wellbeing and energy levels on “ADT.” I already know that I wouldn’t given my particular situation.
PC is a very personal disease that many many men come to experience and manage during their lives.

There is no best solution or treatment that works the best for every man. There is only the treatment that works best for you.
Best wishes and good luck.
GODSPEED

@jeffmarc hello. Firstly, I have to take issue with the doctor who says that your Cancer will come back if you take hormone therapy, I am presuming “TRT!”
TESTOSTERONE REPLACEMENT THERAPY.
That’s just not accurate.
If you currently have detectable cancer cells, “TRT” will feed those cancer cells and it wouldn’t be a good idea. I had been utilizing “TRT” for about 12 years before I was diagnosed with Prostate Cancer. I am basically medically castrated without utilizing “TRT”. My “T” level is between 20-50. I am generally around 750-850 on “TRT,” Without “TRT”
I am basically bedridden and home confined. I have no energy at all. Coupled with serious and debilitating cases of Chronic Fatigue Syndrome and Fibromyalgia for the past 35 years. For your consideration and future research. TESTOSTERONE can’t feed cancer cells that are not there. If the lab report verifies that there is no detectable cancer cells then that’s the best you can do.
Everyman produces Testosterone. If what that doctor is proposing were true, every man would develop Prostate cancer which of course, is not the case. I discontinued my “TRT” a month before my surgery and for 5 months following it. My surgeon and oncologist kept asking me how I was feeling. I told them that I really wouldn’t be able to give them an accurate answer and observation until I started my “TRT”again. After starting my “TRT” for only the first week I was feeling as good as I was before my surgery. Of course, all men are different. Regardless of my Prostatectomy, I require “TRT” just to maintain any kind of normal lifestyle though already measurably reduced because of my “CFS” and “FIBROMYALGIA !”
Due to my long standing “TRT,” I was getting my bloodwork done every 3 months for the 12 years prior to being diagnosed with my prostate cancer. That’s how it was discovered as quickly as it was. All of a sudden my PSA went up from 4 to 6 to 7. I was trending in the wrong direction. The usual tests were done and my biopsy just confirmed it and determined what level I was at.
My PSA was < 0.014 right after my surgery in October of 2022 and has remained the same through today, March of 2026. I still have my blood work and additional bloodwork done every 3 months.

I’ve never heard of any man functioning well in his overall life, wellbeing and energy levels on “ADT.” I already know that I wouldn’t given my particular situation.
PC is a very personal disease that many many men come to experience and manage during their lives.

There is no best solution or treatment that works the best for every man. There is only the treatment that works best for you.
Best wishes and good luck.
GODSPEED

@philipsnowdon You and Jeff Marchi are polar opposites in this debate! Kind of unusual, but it demonstrates how different we all are and how we need to be treated.
He has BRCA2, which makes ADT completely necessary for his survival. You, however, have almost NO natural testosterone, which makes TRT absolutely necessary for you.
Both of you would wither quickly without your appropriate medication so it’s not really an argument over who is right or wrong, but who requires WHAT to keep on living their best life!
Hope you both continue on for a long time…
Phil