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Hormone Therapy (ADT) when ArteraAI Test says it's not necessary
Prostate Cancer | Last Active: 1 hour ago | Replies (25)Comment receiving replies
@jim18 Thanks for your insights. Yes, just based on the descriptions of Lupron vs. Orgovyx when I met with the UofMD doctors, I ruled out Lupron since it lingers and the side effects last longer. They described the ADT as starting before proton therapy and lasting 4-6 months, so throughout and well after 5-1/2 weeks of radiation. Not sure if the falls into neoadjuvant (these terms are all new to me).
I'm not sure if I'd know if I had a 25% buffer of testosterone, but I'll certainly ask the medical team about testing.
And still, the question of whether to trust the ArteraAI testing outcome still lingers. Part of me would like to believe that ADT isn't necessary and just avoid it. After all, it is an esteemed institution like Johns Hopkins telling me this. But I fear recurrence regardless.
Replies to "@jim18 Thanks for your insights. Yes, just based on the descriptions of Lupron vs. Orgovyx when..."
@tjnoffy Yes, Lupron takes time to take effect, and they usually precede it with Bicalutimide (Casodex) in order to minimize the risk of tumor (testosterone) flare. Orgovyx acts more quickly, without the risk of tumor (testosterone) flare.
There have been studies looking into whether it’s preferable to front-load ADT for 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).
NCCN guidelines currently recommend 4-6 months of ADT for unfavorable intermediate (4+3) prostate cancer radiation treatments. (See attached NCCN guidelines chart.)
As for the decision regarding the use of ADT, to paraphrase Falstaff in Shakespeare’s King Henry 4th, Part 1 - “Discretion is the better part of valor.” (Caution is preferable to rash bravery.)
@tjnoffy
Hi,
Yeah I would stay away from Lupron which some people have bad side effects from the drug. Orgovyx seems to be tolerated better by most people, also the effects don’t last for 4-6 months like Lupron.
@tjnoffy As for what constitutes as “exercise” for minimizing the side-effects of such toxic pharmaceuticals as ADT, it involves more than just “…volleyball for a couple of hours twice a week, walks with the wife and dog most days.”
There has been much reported 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
If you do what it takes, you’ll do very well with hormone therapy - it’ll just be an annoyance; if you doesn’t do anything, hormone therapy can be your worst nightmare.
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@tjnoffy neo is before. As far as prostate cancer goes even if ADT does not help it will not hurt. However, your overall health might decrease if you lose bone, muscle, and have low testosterone for the rest of your life. That is the case against ADT. As mentioned, you can take actions to minimize the negative effects while on ADT.
The arterAI test is saying that for your case short term ADT will not improve overall survival. arteraAI is a new test. What did they score you on the 10-year distance metastasis and what percent were you in the intermediate risk group (both on arteraAI report)? I take it you were ST-ADT Biomarker Negative. I do not believe the biomarker(s) used are published so it is hard to comment on accuracy with no history. Other than biopsy slides they have Gleason, PSA, and stage data so not a genetic test.
As far as risk of recurrence did you have a Decipher test from biopsy tissue (it provides recurrence risk)? What percentage was type 4 from biopsy (higher is usually higher risk of both recurrence and metastasis)? Are you going to get a Prostox std test (genetic) for long term radiation GI side effects (calibrated with photon radiation but will be correlated with Photons) risk)?