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

@surftohealth88 Thanks for drawing my attention to that. Obviously my complacency about "only" 6 months of ADT having little effect on my bone mineral density appears to be an ignorant assumption.

I presume the study you quote from is "Effect of Androgen Deprivation Therapy on Bone Mineral Density in a Prostate Cancer Cohort in New Zealand: A Pilot Study" https://pmc.ncbi.nlm.nih.gov/articles/PMC5638161/

I think a guy like Newton would call the bone mineral density loss rates measured in that study "catastrophic".

I'll be studying this topic with a lot more intensity in the next few weeks.

@climateguy
Yes, that was one of the articles that I read and you made me laugh with reminding me of his "catastrophic" comment lol.

Well, since women loose that amount of bone after menopause I guess that is not catastrophic in his opinion - it is catastrophic only for you guys, lol.

Honestly I do not know how we females live at all with such low quality of life 😂, hot flashes and bone loss and low muscle mass, no body hair on top of it all lol - I am starting to wonder should I seek help ?!

Joking to the side, if one can prevent some bone loss I think it is worthwhile trying 🤷‍♀️. Some bunny hopping could be fun after all ; ).

@surftohealth88 the time I heard him say "catastrophic" he was commenting on a rate of bone mineral density loss three times the rate women typically lose bone mineral density

@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 I agree, prudent choice. For me it passes the gut test, and I can't conceive of it doing any harm. Our joints will sound the alarm, if any. I just wish some of these folks would get more serious about their research protocols.

I have Advanced PC and after Chemo have been on Orgovyx for treatment for 5 years. My oncologist after testing and PSA undetectable decided to give me an Orgovyx vacation. Following discussion she is thinking of switching me to Nubeqa instead of Orgovyx once PSA rises. I would appreciate any info on this decision. Is it better?

@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.

@jeffmarc after further thought I have decided to forego orgovyx: although Gleason is (4+3) 7, it is one core from the roi ( region of interest). 2 cores were 6 and the remaining were negative. Although the Decipher is .68 it is the lower end of the high risk and there were no cribiform clusters on pathology. I had a PSA 4 days ago of 2.4 and previous was 2.2. So to take the hormone blocker in order to increase survivability ( decrease biochemical recurrence) by 5-10% does not seem beneficial. It comes down to if this is a localized lesion that will be cured by SRBT or possibility of micro metastasis that will recur down the road. The side effects are not worth the 5-10% benefit of ADT.