IMRT/VMAT Radiation with 6 months of ADT - anyone??

I completed IMRT with short term ADT (Orgovyx) and am doing fine. Testosterone back within 2 months. Did weight lifting, calcium supplements, etc. to minimize damage of ADT. Before doing Lupron read the post about when side effects end. Takes a lot longer on Lupron (4-8 months) to recover and the side effects seem to be worse. I had none of the hot flashes or night sweats on but 50%+ do report these side effects on Orgovyx and a higher percentage on Lupron. Once the injection is made you are stuck in more ways than one.

All of that being said at your age and with your Decipher score I would have chosen surgery. Read Wheel1 post about the latest surgical techniques. If you go this way the selection of the surgeon is critical to minimize side effects.

ADT/ARSI since June 2025, IMRT 20 sessions Oct 2025. Surgery was never an option for me. PSA started rising in Dec 2025 and still is. PSMA PET scan scheduled day after tomorrow to see what's up. Moral of the story...sometimes it doesn't work.

@mjp0512 -thanks for the reply - just saw your profile. Sorry to hear the PSA is on the upswing but at least its not back to 30 - hopefully the PET will be clean

@johnsonjn - Thanks but with PSA rising this fast I think a clean PET scan is out of the question. I'll settle for a bone met or 2 that can be targeted with SBRT. We shall see.

Began ADT w/Orgovyx in October, 2025 followed by SBRT in late November. A blood test in late February, 2026, showed PSA at undetectable level (.02). My RO told me that standard treatment was to continue ADT for 6 more months but I decided to stop it in March and have a PSA/T test in August. He was fine with that. Overall, the only unpleasantness was the side effects after SBRT which lasted about 10 days. The side effects of the ADT were bearable but I noticed a lack of energy - which I pushed through by continuing my normal physical activity - and slight weight gain. My pc was only in the prostate and small lesions in two adjacent lymph nodes. I had a clear PSMA-PET scan and bone scan.

@jim18 Great Feedback - thank you. I am reaching out to my Dr.'s to see if they can flip me from Lupron to Orgovyx. read up on that and it sound like a better choice. I also found the Wheel1 posts and he has a lot of valuable info. but I am still preferring Radiation - the statistics my Oncologist provided are convincing, I see no compelling reason to have surgery but concerned that it comes with a much higher risk of permanent / persistent ED. Why did you opt for RT and how old are you? What type of calcium did you take (there are many i.e. carbonate, citrate )

@cadaddy - thanks for sharing. couple questions if you don't mind; if PSMA/PET was clear how do they detect the small lesions in two adjacent lymph nodes.? Why SBRT (short course) over the longer and lower intensity IMRT? What is your age?

@johnsonjn Both surgery and radiation have lower risk of ED with improved treatment methods. This is nerve sparing for surgery and better targeting that misses the penile bulb for radiation. For radiation you want to have the latest equipment with either MRI or CT targeting of the prostate (ie IGRT). One of these will be built into the latest radiation machines. Even though there is mixed data on effectiveness I followed the surgery penile rehab practice of using 5mg generic Cialis daily during and after treatment. It is cheap and also improves urine flow (not as much as Flomax but with better side effects). Strategy is to keep the blood flow and hope to prevent fibrosis scar tissue a primary cause of radiation ED. As far as ED, Brachytherapy probably has the best profile for least loss (is highest for urethra side effects).

Before getting IMRT you want to get a Prostox test. This is newly (2026) commercialized germline genetics test developed at UCLA that predicts if you are in the 12-13% of the population that have a high risk (avg. 75%) risk) of late radiation toxicity. Most common are ED, radiation proctitis or cystitis. These can occur 1-3 years after treatment. If you are not high risk on Prostox there is still a 7% chance of having one of these symptoms. There is a discussion of Prostox with video on this board. There is a separate test for SBRT with about 20% overlap of a person scoring high on both.

Check with your insurance to make sure the treatment you want is covered. Almost no work insurance (including mine) will cover Proton radiation. May not cover SBRT (5 fractions at 7-8 Gys) as a primary treatment. IMRT at 20 fractions of 3.0 Gys is preferred but up to 39 fractions at lower Gys may be approved. Regardless of the protocol get SpaceOar or other gel to minimize rectal side effects.

On ADT testes shrink 25-50% even in 6-months. Recovery tends to be slower but does occur when off the meds. They will also give you ED which I expected. I took Calcium Citrate w/D3 to minimize ADT induced bone loss.