ADT injection: Benefits worth the toll it will take on my body?

At 62 and prescribed six months of ADT, I'd take it but might want a second opinion. I'm 74 diagnosed with Gleason 7 but metastases to two lymph nodes, so I've had 44 radiation treatments and am in month 16 of 18 on the daily ADT pill Orgovyx. I cannot over-recommend exercise as limiting fatigue and muscle loss. All the best!

You say..."I’m concern with the muscle loss and other adverse affects...."

Well, the side effects of ADT, are well known, particularly
by members on this forum.

Generally:
Muscle and joint stiffness.
Hot flashes
Genitalia shrinkage
ED
Loss of libido
Weight game
Bone density

To a lesser extent, depression.

The answer...nobody knows, which ones or the severity.

There are mitigating strategies you control:
Diet
Exercise - cardio dnd resistance.

Your medical team may want you to take Calcium and Vitamin D3 while on ADT.

There are medications which can mitigate hot flashes.

Whatever side effects you may experience, they generally subside and go away in the first 3-6 months droning on which agent and how long the systemic therapy was.

Your age, baseline T and which agent may play a role on if, how fast and how high your T recovers after coming off treatment.

Generally, MDT plus systemic therapy demonstrates improved PFS and RPFS in various clinical trials.

There is also data that points to MDT by itself can push back the needs for systemic therapy.

In my most recent treatment, MDT by itself was an option. I said no, there is micro metastatic disease to small to be seen by imaging that needs to be dealt with. So, we did 12 months Orgovyx in conjunction with SBRT.

I am at two years, PSA is stable at .03, T is 400+

Would the outcome be different if we had done MDT only? We'll never know since once you make your treatment decision, you own it, no take backs!

As other have said, careful on statistics, they are often outdated and population based,

I say outdated because the pace of medical research is such that statistics can't keep up.

Population based simply means they may not fit your clinical data exactly.

You are not necessarily "wrong" either way, both are "valid " decisions.

What would I do were I you? Keep in mind, I'm 12 years into my journey, so a lot of experience and lessons learned. I would do the six months, Orgovyx, not Lupron, keep an eye on my diet, exercise, manage stress...my experience has been that ADT has not impacted what I do, just how I feel doing it.

Kevin

@kujhawk1978 What is MDT?

@tango32652

Metastases Directed Therapy where treatment, radiation is directed at specific location(s) identified in scans as opposed to systemic therapy where treatment is "indiscriminate...!"

@kujhawk1978 Exactly. And just to add a bit to that, MDT is one of the pillars of the new approach to treating oligometastatic prostate cancer.

In Ye Olden Days (i.e. up to ~5 years ago), most oncologists approached all metastatic prostate cancer the same way: the goal was sequentially-escalating palliative treatment (ADT to ARSI to chemotherapy to the final pain killers) to slow the disease's progression and maintain quality of life until it inevitably killed you in 3–5 years (maybe 7 if you were young and healthy).

Now, things have changed dramatically. Many oncologists distinguish by metastatic load: oligometastatic for just a few metastases (typically under 3–5), polymetastatic for more.

For oligometastatic prostate cancer, they hit it with everything they have up front:

- radiation on each individual metastasis (MDT)

- systemic therapy (ADT+ARSI), and increasingly,

- a large "curative" dose of radiation to the prostate, aka "mothership" as well, to keep from supporting any new or existing metastases.

It's an open debate right now whether oligometastatic prostate cancer can be fully "cured" rather than just managed long term, but studies are showing huge improvements in overall survival and progression-free survival from this new, aggressive approach, applying "curative intent" to treatments for oligometastatic PCa.

(Note: there have also been revolutionary changes in the strategies for treating polymetastatic PCa, but that's not the subject of my post; seach for "triplet therapy".)

@northoftheborder

This supports the evolving discussion of MDT..
https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/165338-integrating-systemic-therapy-and-metastasis-directed-therapy-in-oligometastatic-hormone-sensitive-prostate-cancer-beyond-the-abstract.html
Kevin

Newbie here!

Thanks for all the great information in this thread.
I'm 59 yrs old an just started the "journey". PSA's of 4.38,5.58 and 5.03 in oct, dec 2025 and Feb of 2026, respectively.

Had MRI, then biopsy, then psma Pet Scan to determine stage 2 with a gleason 3+4. Unfortunatley they found a 3 cm mass in my kidney at the same time. So, biopsy, another MRI and then a final stain test right before i was scheduled for partial nephrectomy......and the last test confirmed bengin tumor in the kidney. So....back to the prostate cancer.

I've settled on the SBRT treatment in about 3 months after they give me hormone injection.

My QUESTION for the group is: Is Eligard or Firmagon the better option? My reading says Firmagon but I'm scheduled for Eligard injection tomorrow......ANY advice would be appreciated. Good luck to all of you!!!

Thank you, Daniel

I'm 59 and diagnosed with stage 2 w/ 3+4 gleason score. They are recommending an Eligard shot tomorrow and then SBRT treatment in about 3 months along with a second shot (3 months each)

My question is: is firmagon a better option? Seems to get better reviews? My oncologist is saying this is likely just a 6month plan with 2 Eligard shots...one tomorrow and then one right before the SBRT treatment. When I asked about the other treatments, he said he was open to doing that. My question is, Is one drug preferred over the other? I'm already overweight. Just lost 30 pounds in the last year but got another 35 to go. lol. Beyond that, the side effects seem less daunting with Firmagon. Any thoughts would be appreciated, as I go in tomorrow to either get a shot or postpone.

@ray092271
Thanks for everybody's support, but darn it if I didn't forget a few things...
Yes, I went through the 6 weeks of radiation and, after PSMA-PET showed metastasis, went through 6 treatments off chemotherapy (Taxotere) Subsequent scans showed remission (for about 18 months) but the cancer reared it's ugly head and back to Lumbar spine as well as the prostate itself. Now I've started on Pluvicto. I've only had 1 treatment out of 6, the 2nd in two weeks.
It's important to note that I was fortunate not to have a real major difficulties at each step...none of the 'horror stories' that some go through...I hope that should be comforting to those on a treatment plan...It's no bed of roses, but not a torture chamber either!!
Keep positive, research. I take supplements for support (Hepaprotective, especially Cardioprotective (!!), ALA for the peripheral neuropathy and some others. Doc says one can neither prove nor disprove the efficacy of supplements, but I believe they are beneficial...

I'll tune in after my 2nd Pluvicto treatment...so fa the main side effect is extreme tiredness...and I mean EXTREME!!

Blessings to all

@dantewedge
A very good question...I can only speak from my experiences, But I started on Eligard and was on it for about 1 year or so then developed serious CV issues (Narrowly avoiding heart failure and narrowly avoiding what could have been a major stroke, PVC's, etc.)
I researched it and found Firmagon, and been taking the injections monthly and have had no CV issues since (2 years now).
Be mindful, however, that the belly injection is extremely painful for about 4-5 days. For me, It hurts to bend over (tying shoes, etc), finding a comfortable sleeping position, etc...If you can handle short-term pain, I would strongly suggest Firmagon! Eligard almost killed me!
Blessings
PS: stage IV, metastatic castration resistant...on Pluvictio now...