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

@climateguy

Thanks so much for the "summery" of exercise 👍 !

Do you know by any chance when will his new app. be available with all of those exercises ?

I’m new here and about to start stereotactic radiation for a Gleason 7 (4+3) and decipher score of .68. That’s the bad news. The good is that its localized and .7mm at the anterior transition zone with a negative psma pet and past 2 PSA labs have been under 2.2. I chose SBRT after researching and found same curative results of Robotic vs radiation with radiation having less percentage of side effects ( incontinence and ED). After talking w a few people who had robotic radical prostatectomy, they wished they went w SRBT. My issue is that although I unfavorable intermediate risk by Gleason and “low” high risk based on decipher I would prefer to not start ADT due to the muscle wasting, bone resorption, fatigue. I’ve been given Orgovyx but have not taken it. First treatment is tomorrow. It really comes down to risk of micro metastasis and the SRBT eliminating the localized cancer. I’m leaning towards no ADT and monitor for biochemical recurrence via PSA and pet scans. Any advice/comments. ( I have a background in health care).

@surftohealth88 He's been promoting his "FitMed" app. It exists, and US people can sign up for it. It's available at the "App store" on my iPhone.

What he claims is it will provide some semblance of what he does in his clinic: connect patients with an expert assessment followed up with a prescription as to what exercise medicine as he calls it they should apply in their specific case. Ongoing monitoring will provide patients with modifications depending on the measured results.

I tried to sign up for it. I couldn't understand how to proceed past the intro screens that promise great benefits that won't cost much. I wanted to hear some sort of explanation as to what the app would do and how, and what it would cost. One problem with it for me is it seems to be only accessible with a phone. Another was although the screens were displaying English, the dialect appeared to be Australian. I didn't grasp what some of it even meant.

I wrote the company saying I'm your average American Joe, or maybe not, but I like to see what something is, and what its going to cost before I sign up. I pointed out the difficulty I had in understanding the language they were using. I got a reply back that offered no clarifying information at all. I thought this was incredible. So I haven't tried to get into it again. I keep thinking I should take another look at it....

@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.

@zeits53
The muscle and bone deterioration from six months of ADT are not really a big deal. The benefit they can give for preventing the cancer from coming back Can be significant.

I’ve been on ADT for eight years now. I go to the gym three times a week to keep my muscles up and I’ve been on bone strengthener for about the last seven years. Didn’t need them the first year.

I had six months of ADT when I had eight weeks of salvage radiation, I was 64 and didn’t even notice that the ADT affected me. My brother had SBRT radiation at 77 and they gave him a six month Lupron shot. It did give him hot flashes, but that was the only side effect he noticed. They went away about nine months after the shot wore off but got milder as that time went on.

Orgovyx has the least side effects of any of the ADT drugs. The testosterone comes back real quick after you get off of it most people get it back to real good levels after three months.

You’re probably going to benefit a lot more from taking ADT than not taking it. With the relatively high decipher score you have, it would make sense to take it.

@climateguy While all of this may be true, not all men can do the things he describes. Drop jumping? Bounding over hurdles? Sounds like freakin Boot Camp!😂

I am replying in the context of my earlier posting, "The hope is that with the right weight-bearing exercises, you can reduce the bone loss and the consequential calcification." Newton has some interesting observation relevant to what would be "the right weight-bearing exercises". He recommended impact loading. I think the exercise regimen should be determined by a professional (e.g., physical therapist specializing in these matters) specific to the condition of the individual being treated. For example, for someone with severe osteoporosis (common with ADT), the bones may be too brittle to withstand impact loading. See https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis/art-20044989
One doctor had recommended to me intermittent jogging.
One form of intermittent jogging: [Warm-up Walk] ──> [10-Second Jog] ──> [1-Minute Rest Walk] ──> [Repeat 10-15x].
In another variation (after warm-up) - more for cardio-vascular health and support for controlling cancer: Jog until the heart rate reaches a certain level (depending on age and condition; for me 102) and maintain that for 1 minute. Then, walk slowly until the heart rate drops to the level normal for walking. Then, repeat the cycle a couple of times.

@heavyphil I haven't been able to find it again, but somewhere online there is a brief video of the impact loading exercises, or some of them, that Newton has researched. They all looked completely easy to do. If Boot Camp is a 10, these exercises looked like a 2.

When he gives a talk about this type of exercise, he explains that since he's working with patients who tend to be pretty old, who have advanced disease, and who may not have ever exercised aiming to improve their physical condition up to that point, and he doesn't want to have a study where a significant number of participants suffered grade 3 or higher injury by participating, he is super cautious. He's described not even putting them through the impact loading until he's built them up with a few months of resistance and I think aerobic training.

What I've discovered, not having ever done resistance training aimed at building up muscles before, is that the way to do this has been and is being studied by everyone from body builders to physical therapists to almost anyone you run into in a gym weight room. Newton just researched what effect certain levels of this type of exercise have on various aspects of prostate cancer. He didn't invent the exercises. I suspect impact loading exercise has also been studied by many others for many years, although I haven't looked into it yet. I've only been on Orgovyx for less than 6 months so far so I haven't felt a concern about bone loss.