ADT or no ADT? What should I ask my Oncolgist?

@diverjer
14 years ago, they stopped testing people for PSA at the recommendation of the The U.S. Preventive Services Task Force (USPSTF). This was done because people with a 3+3 were being treated when it was unnecessary.

A friend of ours, that’s a retired gynecologist, was told he had a 3+3 25 years ago and needed surgery. He searched the country and found Dr. Walsh (the book writer) Who had come up with a technique to spare the nerves. He had the surgery with him. They didn’t spare the nerves, for 25 years he’s had ED. He didn’t even need the surgery. The biopsy of his prostate showed very little 3+3.

This is just an example of why they stopped doing PSA tests. Unfortunately, as a result, we are seeing a lot of advanced cases of prostate cancer now because people were not tested when they were younger.

3+3 can frequently just require active surveillance?.

In my case (treated with SBRT) the doctor did not require or advise ADT.
With IMRT, ADT seems to be standard practice.
ADT side effects: Not only bone loss, but the calcium from the bones gets deposited in the blood vessels (coronary; carotid; intracranial)). The resulting calcification is very hard to get rid of. The hope is that with the right weight-bearing exercises, you can reduce the bone loss and the consequential calcification.

@sushilkbirla

Rob Newton, in the article: "Prostate cancer treatment with exercise medicine" https://onlinelibrary.wiley.com/doi/epdf/10.1002/tre.884

" ...we have reported that the combination of aerobic and resistance training has little to no benefit in preventing bone loss in men on ADT and it is only the addition of impact loading (eg hopping, bounding, jumping) that was effective. We have also reported that the combination of aerobic with resistance exercise may compromise growth of skeletal muscle in patients on ADT. This interference effect is particularly evident in these patients due to their catabolic environment, so if the priority is to induce muscle hypertrophy, aerobic exercise should be avoided or limited with a focus on higher volumes of resistance exercise....”

He cites an earlier paper of his where he reported this: "Exercise Mode Specificity for Preserving Spine and Hip Bone Mineral Density in Prostate Cancer Patients" http://iapem.gr/article_files/files/19-4-2019%20Exercise_Mode_Specificity_for_Preserving_Spine_and_1.pdf

My Orgovyx prescription apparently costs the US gov't funded Medicare drug program for geezers $40,000 a year. Newton estimates if patients were referred to exercise oncologists for individual exercise prescriptions during their prostate cancer treatments the cost might be in the neighborhood of $4,000, declining as the years go by.

The impact loading prescription in that paper above is:

2 times a week "The impact-loading component consisted of a series of bounding, skipping, drop jumping, hopping, and leaping activities that produced ground reaction forces of 3–5 times body weight, and was progressive in nature. For the first 12 wk, two rotations were performed of skipping (30 s), bounding over soft hurdles (10 times, 13–16 cm), and drop jumping (10 times, 10–15 cm). In the second 12 wk, hopping on one leg (10 times) was added, and three rotations of all activities were performed. In the third 12-wk period, leaping (10 times) replaced skipping, and for the remainder of the program, four rotations were performed of bounding (19–25 cm), drop jumping (20–25 cm), hopping, and leaping".

It sounds weird, but precise. It works he says. My medical oncologist appears to know nothing about exercise to ameliorate the side effects of ADT.

@climateguy
Rob Newton has spoken at more than one large prostate cancer conference.

A lot of doctors are aware of him.

I think it might be a little bit deceptive to say most people could stop taking ADT if they just did the exercises Newton recommends. The combination of the drugs with exercise can stop or delay reoccurrence. I wouldn’t want to risk my life just on exercise.

@sushilkbirla

Rob Newton, in the article: "Prostate cancer treatment with exercise medicine" https://onlinelibrary.wiley.com/doi/epdf/10.1002/tre.884

" ...we have reported that the combination of aerobic and resistance training has little to no benefit in preventing bone loss in men on ADT and it is only the addition of impact loading (eg hopping, bounding, jumping) that was effective. We have also reported that the combination of aerobic with resistance exercise may compromise growth of skeletal muscle in patients on ADT. This interference effect is particularly evident in these patients due to their catabolic environment, so if the priority is to induce muscle hypertrophy, aerobic exercise should be avoided or limited with a focus on higher volumes of resistance exercise....”

He cites an earlier paper of his where he reported this: "Exercise Mode Specificity for Preserving Spine and Hip Bone Mineral Density in Prostate Cancer Patients" http://iapem.gr/article_files/files/19-4-2019%20Exercise_Mode_Specificity_for_Preserving_Spine_and_1.pdf

My Orgovyx prescription apparently costs the US gov't funded Medicare drug program for geezers $40,000 a year. Newton estimates if patients were referred to exercise oncologists for individual exercise prescriptions during their prostate cancer treatments the cost might be in the neighborhood of $4,000, declining as the years go by.

The impact loading prescription in that paper above is:

2 times a week "The impact-loading component consisted of a series of bounding, skipping, drop jumping, hopping, and leaping activities that produced ground reaction forces of 3–5 times body weight, and was progressive in nature. For the first 12 wk, two rotations were performed of skipping (30 s), bounding over soft hurdles (10 times, 13–16 cm), and drop jumping (10 times, 10–15 cm). In the second 12 wk, hopping on one leg (10 times) was added, and three rotations of all activities were performed. In the third 12-wk period, leaping (10 times) replaced skipping, and for the remainder of the program, four rotations were performed of bounding (19–25 cm), drop jumping (20–25 cm), hopping, and leaping".

It sounds weird, but precise. It works he says. My medical oncologist appears to know nothing about exercise to ameliorate the side effects of ADT.

@jeffmarc Newton isn't saying exercise replaces all other therapies.

I found a quote from him: "“Exercise will never cure cancer by the way. It's an adjuvant treatment to support chemotherapy, radiation therapy, surgery, and immunotherapy. And improve your quality of life. Unfortunately a lot of the other treatments make your quality of life worse for a while, until you recover. But exercise always makes your quality of life better”