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

Maybe I misremember what Arterra recommends. I thought it was whether a second drug abiraterone (Zytiga) would be of benefit if added to the primary ADT agent. About 25% are recommended to take it; whereas about 75% would not benefit from adding to the primary ADT drug.

Maybe I misremember what Arterra recommends. I thought it was whether a second drug abiraterone (Zytiga) would be of benefit if added to the primary ADT agent. About 25% are recommended to take it; whereas about 75% would not benefit from adding to the primary ADT drug.

@thmssllvn
If you are on ADT alone for more than a year, it increases your chance of becoming Castrate resistant. If you add a drug like abiraterone or a lutamide That can extend the amount of time It takes.

Is ADT keeping you undetectable?

@jeffmarc Curious, Jeff…didn’t Dr Weisserug prove to you that notion to be false in an email he sent you?That being on ADT early prevents castrate resistant clones from developing? And that long term ADT does not automatically cause castrate resistance?
He has been on Estradiol patch for like 16 yrs and is doing well so far…thoughts? Best,
Phil

@heavyphil
He said essentially that the cancer cells will accumulate and get hit by cosmic rays and then convert to resistance.

It makes me think that when you are on ADT some cells still accumulate but if you are on estradiol, you don’t have that problem. I don’t know if that is true, I do know the few people that I know of that are on estradiol do not have a problem yet. And some people that were on ADT for many years alone, didn’t have that problem.

I do know that I was on only ADT for 2 1/2 years and became castrate resistant. Something happened to those cells. Predictions of how soon somebody will become castrate resistant after being on ADT alone say, it’s a median of two years.

@jeffmarc OK, that’s interesting…but I think in your case the BRCA mutation pretty much makes your cancer aggressive which then leads to castrate resistance; I’ve read some studies - I’m sure you have read them all - where men are first tested for BRCA only because ADT stopped working; once they were found to have the mutation they were placed on PARP inhibitors.
Are you on one?
I think you were on Zytiga or Nubeqa but those aren’t PARP inhibitors. Thanks!
Phil

@heavyphil
When I became castrate resistant to ADT, they did not know I had BRCA2. so I was put on Casodex for 15 months and then Zytiga. After 2 1/2 years, I switched to Nubeqa. I did take a PARP inhibitor for about five days, Then I spoke to my oncologist and said, This doesn’t make sense why aren’t I on Nubeqa, And she agreed to put me on it. Since it is work so well, there’s no need for me to be on a PARP until after it fails.

I found out I was BRCA2 in March 2022 while I was on Zytiga.

The side effects of the PARP are pretty serious so I really would like to avoid it as long as possible.

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.