Hormone Therapy (ADT) when ArteraAI Test says it's not necessary

I’ve read through your (& some others’) comments on this thread. But, I’ll respond to each of yours separately —>

(Background: At 65y, for a localized, Gleason 7(4+3), PSA 7.976, I had 28 fractions of proton radiation (2.5 grays per fraction during April-May 2021), with 6 months (two 3-month injections) of Eligard. So, our numbers are similar.)

I had discussions with my urologist (a surgeon), focal therapists (cryo, HIFU, & laser ablation), SBRT (Cyberknife & TruBeam), brachytherapy (LDR & HDR), as well as IMRT (photon) and proton. Each specialist indicated that their protocols would successfully treat my disease. I chose proton; the deciding factor for me was proton’s Bragg-Peak characteristics. I had treatments at the University of Cincinnati, just a 40-minute highway drive from my home.

There are two recent clinical trials comparing proton with photon for prostate cancer treatments - COMPPARE (comparing effectiveness, side effects, and patient-reported quality of life) and PARTIQoL (comparing quality of life and tumor control). Both studies indicated similar tumor control rates and patient-reported quality of life (QOL) outcomes. (Why proton radiation is generally considered superior for treating other solid tumor cancers located near critical, sensitive structures due to its precise targeting and reduced entry, scatter, and exit doses, leading to fewer side effects, but (for some reason) not prostate cancer, I don’t know. That goes into a much deeper discussion about clinical trials.)

The ArteraAI prostate test was not FDA-approved until mid-2025 so, I did not have access to that test. Also, Orgovyx (Religolix) was not FDA-approved for prostate cancer until late-2020 so, I did not have access to that ADT either.

As for an ArteraAI result of “not likely to benefit from hormone therapy”, I would probably take it anyway. The downside of 4-6 months of ADT is minimal, and I would tend to “slightly” overtreat the disease than undertreat it and (possibly) have to come back at it a second time.

There are fairly simple ways to minimize most ADT side-effects, so I wouldn’t let the “don't want to deal with ADT side effects” impact that decision. You also followed that comment with “…in addition to the many others I will endure.” What other side-effects do you think you’ll be enduring?

Prior to starting my six months of ADT hormone therapy, my medical oncologist thoroughly explained both the physical and mental health adverse side-effects of hormone therapy and how to avoid/minimize them —> with resistance training exercises.
> physical: weight-bearing exercises that maintain lean muscle mass helps offset the physical side-effects.
> mental: exercise turns on many “switches” in parts of the brain that put us in a better mood. It reduces stress, anxiety, depression, catastrophizing, and more.

She advised me that incorporating resistance-training exercise was a necessary part of the routine to minimize the potential physical/mental side-effects of hormone therapy.

Except for having zero libido due to the low testosterone, everything still worked. From what I was told by my medical oncologist, the key is to continue doing it, despite the “want to” not being there. Perhaps due to ramping up my resistance-training and cardio exercise programs to minimize the side-effects of hormone therapy, that might(?) also have had the side-benefit of keeping the blood flowing “down there” as well; I don’t know. Much of what goes on “down there” is about hydraulics so, keeping the blood flowing would seem to be important.

Ultimately (of course), the decision is yours.

@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.

Neither decision is wrong...

I am not an advocate of using OS in my treatment decisions, too long, too many things change brought about by medical research and life happens in the meantime, the plane you're on goes down...Rather, PFS, RPFS, SEs

There is literature, aka, clinical trails which indicate MDT may push back the need for systemic therapy, this may be useful in making your decision - https://www.urotoday.com/conference-highlights/apccc-2026/168595-apccc-2026-in-which-patients-is-metastases-directed-therapy-without-systemic-therapy-sufficient.html

As others have said, if you decide on short term ADT, Orgovyx allows you to stop if the SEs are too much or if you complete the "full term," T recovery is generally faster. As o its SEs, same as Lupron, which ones would you experience and heir "severity," you won't know until you try. I've done 18 months of Lupron and 12 of Orgovyx, SEs were generally the same, recovery after were the same. As @jeffmarc says, the only difference in being on versus off ADT for me was not what I did, it was how I felt doing it, in March 2018, I did the Bataan Memorial March in White Sands, NM with my sister, 26+ miles hike through the desert, 14 months into my 18 months of Lupron.

You can always go the minimalist route, do the MDT, see what happens and go from there.

Kevin

@heavyphil

The latest studies like at Duke indicate that only about 5% of men benefit from ADT while 100% suffer from side effects that can be life shortening. I am eagerly awaiting the AI testing by Duke to determine the characteristics of the 5% who benefit from ADT.

@pesquallie A bit misleading…5% of WHAT men? What Gleason score, category, Decipher, etc?
There are way more than 5% of men living with metastatic PCa that are only still alive because of ADT.
Yes, there are SE’s but not all men suffer from them and some react much less than others. AI still only ‘knows’ what WE know - it’s more like a Vegas odds-maker at this point, giving its best opinion on hundreds of studies that have already been done. It still cannot ‘think’ for itself.
Phil

@heavyphil

The Duke report indicates that aggressive prostate cancer responds best to high testosterone levels which is in sharp contrast to old methods.

@pesquallie Not totally. This study gave insight on why BAT therapy seems to work in aggressive cases.
It does not suggest that aggressive PCa is treated with T by itself.
The ADT and the T are cycled on and off in an attempt to confuse the mechanisms fueling cancer growth.
They have been using BAT for decades with some success; maybe now they can figure out how to make the results last longer and thereby extend longevity in men with aggressive disease. Best,
Phil

@heavyphil
On the question of "who benefits from ADT and is it worth the side effects"? I just had an appointment with my RO at Johns Hopkins where he considered whether to add ADT to SRT. (Short story: I had RALP in 9/25; PSA still low but rising; aggressive cancer (IDC, Cribriform, EPE, Decipher .89, but clean margins on pre-surgery PET). The determining factor for him to add ADT was the detailed report that accompanied the Decipher one page summary. It showed I had Luminal B, an aggressive subgroup. The trial (which has not yet been peer reviewed) NRG GU006 (BALANCE) showed a clear benefit of adding apalutamide to SRT. If you have a high Decipher score, ask your doctor to get the detailed report that accompanies the one page summary. You can also google "NRG GU006 (BALANCE) and Luminal B" to see a discussion of the study.