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ADT started before SRT or concurrently?

Posted by animate @animate, May 5 3:46pm

I am waiting on my appointment in a few days with my Oncologist to define my SRT, Biochemical Recurrence treatment plan after I had RALP back in November 2025, due to PSA rising over the past two months, up to 0.21 currently. It seems like most likely 6 months of ADT will be required.

In preparation, I have already been scheduled for a radiation simulation, to map out with the radiation equipment the area to be treated and to put tattooed reference markings on me.

From the fact that I will be having this simulation in a few days, it would appear as if the intention is to start SRT very soon. I have read that the usual practice is to start ADT a few weeks before starting the SRT treatment, to help weaken the bad cells and make them more vulnerable to the radiation when it starts.

I would appreciate any comments or experiences regarding this. Did anyone start ADT along with your SRT treatment at the same time or was ADT started a few days or weeks in advance?

Thank you.

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animate | @animate | May 6 2:19pm
In reply to @brianjarvis "@surftohealth88 Dr. Kwon (of Mayo Clinic) has a 2019 PCRI presentation addressing Mayo’s protocol for salvage..." + (show)
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@surftohealth88 Dr. Kwon (of Mayo Clinic) has a 2019 PCRI presentation addressing Mayo’s protocol for salvage treatment of recurrence (following surgery and radiation). At various places in his presentation he covers what you’re asking about.

See Dr. Kwon’s presentation about recurrence at: https://youtu.be/Q2joD360_pI)

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@brianjarvis
Thank you for the video link. Interesting presentation.

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animate | @animate | May 6 2:21pm
In reply to @heavyphil "Hey bud, My Orgovyx was started 10 weeks before SRT, continuing during SRT, and then continued..." + (show)
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Hey bud, My Orgovyx was started 10 weeks before SRT, continuing during SRT, and then continued for 10 weeks after - 6 months total.
Phil

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@heavyphil
Thank you for sharing your experience. I see that you also started your ADT weeks before starting the radiations.

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animate | @animate | May 6 2:27pm
In reply to @jim18 "The cancer cells will be weakened with ADT either before or after. Unless you are using..." + (show)
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The cancer cells will be weakened with ADT either before or after. Unless you are using SBRT (8 Gys doses, etc.) the radiation causes DNA damage, but death takes months to years to complete. Studies have shown ADT is more effective concurrent and after, although these were done with primary treatment. Studies also show sRT is more effective if started at lower PSA (disease) levels. If PSA is rapidly increasing it is probably better to start ADT right away to arrest the peak PSA at a lower level (no studies on this). With your schedule for a quick start to treatment, it probably does not matter.

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@jim18
Thank you for your response. As you state, I have not been able to find much info on the generally accepted guidelines for when to start ADT in Biochemical Recurrence cases. I am supposed to begin soon but I still don't know if ADT will be administered in advance to SRT and I am just trying to be informed about the advantages or disadvantages of this, to be well prepared to discuss, when going into my appointment with the Oncologist next week.

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brianjarvis | @brianjarvis | May 6 8:34pm
In reply to @animate "@brianjarvis Thank you for sharing your experience and for the interesting article. Besides the Casodex and..." + (show)
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@brianjarvis
Thank you for sharing your experience and for the interesting article. Besides the Casodex and the Eligard, at what point was your first ADT injection administered? Was this before starting your radiations or at the same time?

Good to hear that things are going well for you and my Best wishes that they stay that way.

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@animate I kept all that information in my PSA tracking chart (see attached).
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Setters and Birds | @jonathanack | May 7 7:59am

I had Orgovyx prescribed about 8 weeks in advance of SBRT (5 sessions). I have cribriform (3+4). I am 64, gleason 7 with cribriform in 2 tumors, gleason 6 in 4 tumors - surgery vs. radiation werequipoise per my oncologists and 2 second opinions at MSK and Smilow). I remained on Orgovyx for another 8 weeks or so. About 16 weeks in total for Orgovyx. As soon as I started the Orgovyx I was advised to maintain a routine exercise schedule. This helped A Lot! The radiation (barigel spacer in place as well) came with some fatigue that was entirely manageable. All done as of late February with undetectable psa and pretty close to normal in all other areas (still using flomax and some occasional fatigue).

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Jeff Marchi | @jeffmarc | May 7 11:56am
In reply to @jonathanack "I had Orgovyx prescribed about 8 weeks in advance of SBRT (5 sessions). I have cribriform..." + (show)
Profile picture for Setters and Birds @jonathanack

I had Orgovyx prescribed about 8 weeks in advance of SBRT (5 sessions). I have cribriform (3+4). I am 64, gleason 7 with cribriform in 2 tumors, gleason 6 in 4 tumors - surgery vs. radiation werequipoise per my oncologists and 2 second opinions at MSK and Smilow). I remained on Orgovyx for another 8 weeks or so. About 16 weeks in total for Orgovyx. As soon as I started the Orgovyx I was advised to maintain a routine exercise schedule. This helped A Lot! The radiation (barigel spacer in place as well) came with some fatigue that was entirely manageable. All done as of late February with undetectable psa and pretty close to normal in all other areas (still using flomax and some occasional fatigue).

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@jonathanack
My brother also had small cribriform With a Gleason 4+3. He had five sessions of SBRT radiation at 77. He’s 80 now and his PSA is just fine.

Do you know whether your cribriform Was large or small? That can make a big difference.

He was on Lupron for six months. Sure, wish she had been on Orgovyx.

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Setters and Birds | @jonathanack | May 7 7:43pm
In reply to @jeffmarc "@jonathanack My brother also had small cribriform With a Gleason 4+3. He had five sessions of..." + (show)
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@jonathanack
My brother also had small cribriform With a Gleason 4+3. He had five sessions of SBRT radiation at 77. He’s 80 now and his PSA is just fine.

Do you know whether your cribriform Was large or small? That can make a big difference.

He was on Lupron for six months. Sure, wish she had been on Orgovyx.

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@jeffmarc
I do not know. I just reviewed my information on the patient portal and do not see an indication re: large or small. I have made a note for my next appointment to find out (and can reach out via the portal to confirm). Orgovyx was not a particularly trying medication. There were definitely some physical changes very low energy, libido, and some bouts of depression (I guess were helped along by the drug). However, from what I have read about alternative ADT options an easier road.

I'll check on large vs. small and report back.
Jeff, thanks for all you do on this site. It makes a difference and is sincerely appreciated.

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