Hormone therapy before radiation treatment question....

Well before starting ADT, my medical oncologist advised me to begin a robust resistance-training exercise program - weightlifting, TRX, or other significant weight-bearing exercises that one would do to maintain lean muscle mass. That’s the way to minimize the side-effects of hormone therapy. For me being a gym rat anyway, that was easy to do.

At 65y/o (in early 2021), I had 28 sessions of proton radiation + 6 months (two 3-month injections) of Eligard + SpaceOAR Vue.

The only side-effects of the ADT that I experienced were muscle atrophy (about a 30% loss of strength), loss of libido, and very mild “warm” flashes. I did not experience any of the other side-effects that most men mention they experience to varying degrees —> anger, depression, mood swings, emotions, forgetfulness, confusion, memory loss, fatigue, ED, hot flashes, night sweats, muscle atrophy, weight gain, and more…. In fact, due to the robust resistance-training exercise and cardio programs I engaged in, I actually lost 40 lbs (and 3 belt sizes)!

Since then, I’ve come across a number of informative sources on the physical benefits of resistance-training exercise while on ADT. Here are just a few that I’ve bookmarked:

> Drs. Sholz and Moyad talking about exercise and hormone therapy: https://m.youtube.com/watch

> A paper on The Benefits of Exercise During Hormone Therapy: https://static1.squarespace.com/static/54c68ac6e4b06d2e36a4b8c9/t/55cb7275e4b0d97ae7ff60af/1439396469154/The+Benefits+of+Exercise+During+Hormone+Therapy_Insights+August+2015_PCRI.pdf

> A study about the benefits of exercise to counteract the adverse effects of ADT: (They describe a good resistance-training program): https://journals.lww.com/acsm-msse/fulltext/2023/04000/resistance_exercise_training_increases_muscle_mass.2.aspx
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Yes, the data show that you can maintain a relatively normal quality of life while on ADT - you just have to be committed to do what it takes. Most don’t (or won’t or can’t).

My situation was almost identical to you except my PSA was 7.1, clear MRI, two positive biopsy cores 3 +4 = 7 and 4 +3 = 7. I was treated at Emory Winship Cancer center with:

- Bargiel rectal spacer
- 5 weeks daily IMRT radiation
- 6 months Orgovyx ADP pills
- One single High Dose Brachytherapy procedure

Now 12 months post treatment I can say the only ADT issues I had was intermittent fatigue on hot days (lasted only a few minutes), some minor weight gain, and moments of heightened emotions for no particular reason.

I did not notice any muscle or bone loss but I did experience a few days of strange shin pain just after starting the Orgovyx. The pain disappeared a few days later and never reoccurred.

I walked and continue to walk 30 - 40 minutes five days a week. I have heard exercise is key to avoiding ADT side effects.

I have read conflicting reports on the true benefit of ADT with a radiation treatment plan. My RO strongly suggested I take the Orgovyx and said "if I were in your shoes...I would take it...it won't kill you". At the time, he said my chances for a positive outcome would be improved with the ADT for six months.

Thankfully, my PSA stands at .1 and one year later I feel as good as I did prior to being diagnosed and treated. I hope the same for you.

@jeffmarc
"....there is no test that can show whether or not you have cancer cells left."
This is very nearly precisely what my radiolgist (Weil Cornell/MSK/HHC Tallwood - trained) advised me last week. I had asked: '...what's left of the cancer' and he carefully explained what Jeff notes.

Separately, I am 27 days since my last orgovyx pill and 12 weeks post SBRT. Orgovyx was easily tolerated (some fatigue, some arousal decline - but not entirely) and no one would know anything was going on. I did have some voice/vocal hoarseness that is persistent yet. ADT, from every source and conversation I have had, is absolutely a key part of treatment for the vast majority of patients.

Go Easy fellas...

As for “…The Dr recommends 6-8 weeks of daily ADT treatments (pill) prior to radiation...”

What matters just as much is how long after radiation treatments does the ADT continue?

There have been studies looking into whether it’s preferable to front-load ADT with radiation treatment or backload it.

This is a paper titled - “In Prostate Cancer, ADT After RT Better Than Before RT” - that was presented at the American Society for Radiation Oncology (ASTRO) 2020 Annual Meeting —> http://www.medscape.com/viewarticle/940049)

It discusses whether (and why) ADT with (and after) RT leads to better outcomes than ADT well before RT (which is how it is usually given).

The paper then explains the details of how this mechanism works, and follows with “… radiation damage to DNA can continue long after the radiotherapy itself has been completed. So by keeping the androgen receptor inhibited or suppressed by hormone therapy, you can suppress that DNA repair mechanism for months, and this is why [I think] adjuvant ADT is a very important component to kill prostate cancer cell…”

The paper then goes into much detail describing the combined analysis to determine the optimal timing (adjuvant vs neoadjuvant) of ADT with radiotherapy for patients with localized prostate cancer.

The study’s conclusion favors “an adjuvant rather than neoadjuvant-based approach,” and it has to do with ADT’s continued suppressive effects after radiotherapy to help radiation kill prostate cancer cells.
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In English:
> Radiation damages the DNA in prostate cancer cells, even after the radiation treatments end.
> ADT systemically lowers testosterone.
> Which starves prostate cancer cells.
> This keeps the androgen receptor inhibited.
> Which suppresses the DNA repair mechanism long after radiation treatments have ended.
> Preventing them from reproducing.
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@capatov I had almost exactly your treatment (26 IMRT sessions and one HDR-B session) but one year of ADT rather than 6 months. The one year of ADT for my 3+4 case was justified because of my 0.81 Decipher score. Did you ever get a Decipher test? If you had a high Decipher score it sounds like you handled ADT well enough that doing a year of ADT would not have been a problem for you.

I did not get a Decipher score to the best of my knowledge. My RO said six months would be plenty of ADT for me. I forgot I did have one more issue on ADT - elevated blood sugars and triglycerides during the course of treatment. Once the ADT ended both returned to normal w/in 30 days

There are other recent posts including an important PRCI video that suggests recent research shows all Gleeson 7 intermediate risk PC patients (3+4 and 4+3) do not need any more than 6 months of ADT to get the full benefit of this therapy. In fact, over 12 months of ADT has been shown to cause death by heart attack and causes other than PC

Others on this forum have posted on this issue in great detail....

@stew80 I think your "low risk vs. high risk" distinctions are accurate.

I was sort of in the middle on the risk continuum. I was Gleason 4+3=7 unfavorable, PSA = 8.1 and more than half of my biopsy cores were positive. I used ADT for eight weeks before my SBRT radiation treatments and was so glad I did.

It's just my opinion, but I do think the ADT weakened the PCa and likely made my SBRT treatments more effective. PSA went to 0.1 four weeks after SBRT completion and it stayed there.

Yes, ADT sucks, but PCa sucks even more.