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

@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 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!😂

@jeffmarc thanks so much for your advice. I think I may start Orgovyx and see what the side effects are like. Previous to my pos biopsy I intermittently took testosterone and now having gone 3 months w/o it I am fatigued and the sarcopenia is evident. But if as you, I’m able to continue to the gym ( hiit classes) and accept that I might be able to recover from the side effects, it’s worth a trial.
Do you know anything about the testosterone saturation model?

@climateguy Impact loading is as easy as running down hill on a hard surface, or down a flight of stairs (make sure not to fall). The combination of gravity and velocity creates quite a force on the legs.

@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.

@climateguy Thank you, this is very helpful. For those who want to cut to the chase on Newton's "impact" exercise prescription (as used in the study cited in the "Exercise Mode Specificity...." article), here it is: "For the first 12 weeks, 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 weeks, hopping on one leg (10 times) was added, and three rotations of all activities were performed. In the third 12-week 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." (I made tiny edits for grammar / readability.)

All that is interesting and matches my common sense, so I'll likely add impact training to my aerobic / strength regimen.

BUT: Newton's sample sizes were small (a typical medical study bugbear): Subtracting people who wandered away before the 12-month study ended, the 3 randomized groups had 37, 44, and 29 people left in their cohorts. Not exactly disqualifying, but not very solid, either. More importantly, the impact / resistance training group got much more rigorous supervision than did the aerobic / resistance or the delayed / aerobic groups. The latter two were basically "sent home" to do unsupervised, unverified self-treatment for the second 6 months and the entire 12 months of the study, respectively. After that, the most sophisticated statistical analysis you could apply would just be putting lipstick on a pig. Not to mention the overlap between (some) aerobic and impact activities. (For me, the act of running boils down to about 180 "impact" crashes per minute. So which study cohort would I fall into?)

All that said, I'll still look into Newton's prescription. For all the study flaws, the basic idea still makes a lot of sense to me. So thanks again.

@guybe Thanks for you analysis.

Newton talks about the effect impact loading exercise has on bone loss in his latest 2025 talks, citing this 2019 study. He may have done more work, or he may be aware of other work. I'm going to be researching this further.... I want to incorporate some efficient impact loading into my routine especially as my ADT lasts longer than 6 months.

Ask your oncologist about the ArteraAI test to determine the benefits of ADT. It was invaluable for my decision not to add ADT to my SBRT. The test uses biopsy slides and AI algorithms to offer a customized opinions/recommendations.My Gleason score was 3+4. Good luck; information is power.

@climateguy
Some studies show that the most loss actually happen in "acute" stage of ADT treatment (initiation of ADT) :
"Men on acute ADT had a similar rate of bone loss to men on chronic ADT. Reversibility in ADT-induced bone loss was observed in those who discontinued ADT. Serum levels of PINP and CTX were higher in acute and chronic ADT users and levels returned to the range of PCa controls when treatment was withdrawn."

I think that it is wise to do all that one can do to prevent bone loss as soon as ADT starts.