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

Hi - I just finished 28 radiation therapy sessions and had received 2 doses of 22.5 mg Lupron 3 months apart. I experienced hot flashes but none of the other side effects mentioned in literature or comments on this site. However, my hemoglobin dropped from 16 to 13.5 in 6 months. I received an extra 7.5 mg dose because my radiation therapy went beyond the 6 month coverage. I did not experience any weakness or problems with continuing my karate training and pickleball/tennis practices. I do have urinary complications from Lupron and radiation but they are now easing off with ibuprofen and water intake. Like you, I did not want surgery. At 71 years of age, I wanted to continue practicing my martial art (54 years of continuous training). Recovering from surgery would have prevented that, I think. Everybody's experience is different but this is what I had experienced so far. Good luck.

@johnsonjn
The PSMA/PET scan did show an uptake in the two adjacent lymph nodes but since there were no other uptakes my urologist said they would be taken care of at the same time as the prostate. The long term IMRT was suggested to me by one RO but having learned about the comparative success rates of both I asked why not SBRT. He said that it was experimental and not FDA approved. I suspected that he was directing me to treatment on machines that were available locally that did not have SBRT capability. I contacted MSK for a second opinion and met with an RO there who said SBRT w/ADT was the appropriate treatment. That suited me since I could have the treatment over 8 days and be done with it rather than 5-6 weeks of daily treatments that required a 2-hour round trip. I am now 80.

@panch0 - thank you for sharing your experience! Sounds like you are doing well with exactly what my RO has prescribed for me. I am looking for compelling reasons to choose one of the treatment options (RT vs RP) over the other - a daily, if not hourly mental struggle.

@johnsonjn Get the Prostox test for the type of radiation you want. If you score high-risk on the IMRT test you have 12x the risk of late radiation effects (mostly urinary & ED) vs. low risk. For SBRT (separate test) it is 9x the risk. Surgery has a lower risk profile (especially with a great surgeon) if you score high risk on both since your risk would be much higher than the RO' population stats. If not (< 15% test high) you can go with radiation knowing your risk is lower than the RO' stats. See the Prostox - learning post comment by kjholz on 5/1 that gives the exact wording from both tests. He was in the 2% at high-risk on both. He went with Tulsa-Pro due to Prostox results.

Just to clarify, yours is De Novo...

You ask "Is there anyone in this forum that has completed or is currently taking radiation with ADT...?"

I've done it twice, though for different reasons, recurrence, not De Novo.

First time was in 2016 as part of triplet therapy, Six cycles Taxotere, 24 months of Lupron and whole pelvic lymph node, 25 IMRT 45 Gya.

The 2nd time was as part of doublet therapy, 12 months Orgovyx and SBRT, 5x8Gya to a lymph node identified in a PSMA scan.

You say your treatment options are:

RP
Radiation IMRT/VMAT with 6 months of ADT (Lupron injection)
Radiation without any ADT

Your comment about being inclined to avoid surgery is not uncommon given the possible side effects.

The side effects of ADT are generally well known. The question is, which ones may you experience and what may be the severity? Won't know until you try it...

MY experience after surgery was no incontinence, recovered sexual function withing a year. Others do not share my experience....

I've done radiation three times, SRT, WPLN and SBRT. That's 69 times on the table, 155 GYa. Side effects, none. I do vividly remember my radiologist telling me that during SRT the nerves could get "fried" and I would have ED.

As to the ADT, usual side effects, muscle and joint stiffness, fatigue, damn hot flashes, weight gain, genitalia shrinkage. I did not experience loss of libido, nor do I experience ED and I could achieve orgasms...Again, others do not share this experience.

The mitigating strategies while on ADT care generally ones you control:

Diet
Exercise
Managing stress

Your medical team can help with the hot flashes, depression if you have that, you should stay on Cialis or Viagra, I did 5mg Cialis daily. Likely you'll have to ask for support on these, your medical team probably doesn't volunteer.,.

Recovery in part may be a function of:

Baseline T
Age
Time on ADT
Agent used.

In both cases, my T recovered to 400+ within the first 3-6 months, with that, away went the side effects.

Again, MY experience.

With just six months of ADT, your recovery should be similar.

Treatments you mention are all valid choices. Have you discussed doublet therapy?

Kevin

I'd strongly consider getting the
Prostatectomy

That way a pathologist can thoroughly eyeball the prostate and its grade, extent, and whether any may have escaped.

My biopsies had me at the unfavorable 4+3 dominant. As you'll see below that became in a major way a far more favorable 3+4 on the prostatectemy.

Also worries about the sexual nerve bundles being preserved they can be so precise now that if they say one or both can likely be preserved, it's really a Doc's way of saying "in all likelihood".

The reason I chose the prostatectomy is I wanted to better know what I was up against.

I'm reminded of an adage that was drilled into my head as an infantry lieutenant training for Vietnam:
"Lieutenant-Always bring the Old Man bad news first. Good news takes care of it self."

Ironically Nam is probably where I got my dose thru Agent Orange (On permanent VA disability) On that score - maybe we shouldn't have been in that war. But once there - if they hadn't used Agent Orange there'd be a lot more names on the Wall. Including probably mine. So no tears here.

Here's my story
lymph-node-only oligometastatic metachronous prostate cancer Gg 2 with Gleason 3 at 80% and Gleason 4 at 20 %, . Under treatment for 8 years and PSA never exceeded 6.7

Prostatectomy 2018
--stellar pathology report
------Gg 2 with Gleason 3 at 80% and Gleason 4 at 20 %,
No epe, no positive margins, no vesicle invasion, no cribriform, no intraductal, left nerve bundle spared, N0, M0, adenocarcinoma

One draw back was +PNI

PSA undectable for only 13 months (little over a year) then BCR given owise stellar pathology report +PNI likely culprit.

Salvage radiation 2019 at PSA 2.5 without ADT and psa nadirs 0.2

NOTE ESPECIALLY THIS:

2021
PSA RISES AND IMRT W 6 MONTHS ADT DROPS IT TO UNDECTABLE FOR 4 MONTHS

SO IMRT WORKS!!!!

Psa rises to 3.7 and sbrt administered 08/2024

Psa rises to 3.7 and 3 month xtandi administered dropping PSA undectable again. The xtandi was monotherapy and testosterone was maintained at 350. So when xtandi wore off psa rose quickly to 6.6 but dropped to 6.2 in two weeks. Clinician believes further psa drops very likely taking psa back to at least 3.7

Importantly the second dose of xtandi for one month resulted in psa dropping from 6.6 to 0.5 with tesosterone maintained at 524.
Also conventional imaging has been negative all 8 years and psma pet scans continue to show only a few subcentimtere lesions with SUVmax never above 10.

Perhaps too long-winded.

But my main thought its my view the prostatectomy gives one the best understanding of where he stands (eg no EPE etc) and offers the possibility of a cure. But IMRT with ADT is also very effective as in my case taking PSA to undectable for 4 month's after it.

GOOD LUCK

@kujhawk1978 thank you for the reply, I am digesting all that information. You were about 58 when you had the RP ?
Yes on the doublet therapy (new term for me) --Dr. prescribed Casodex (an androgen receptor blocker ) with the Lupron

@kujhawk1978 thank you for the reply, I am digesting all that information. You were about 58 when you had the RP ?
Yes on the doublet therapy (new term for me) --Dr. prescribed Casodex (an androgen receptor blocker ) with the Lupron