@cbball Yes, doing one’s own homework is crucial to getting a desired outcome (the definition of which can vary person to person).

Similarly, being a retired computer scientist, I was into the technical and analytical details of the treatments. I don’t think I was a “pain in the ass,” but I had questions regarding diagnostics and treatments for which my doctors would comment “No one has asked us those questions before.”

I was initially diagnosed (in 2012) with low-grade, localized disease (PSA 4.2, Gleason 6, with no other adverse risk factors), and the urologist wanted to do a prostatectomy. I chose to go on active surveillance which lasted for 9 years. (But over those years he was good enough to provide me referrals to specialists in any treatment modality I requested, so that I could interview them while doing my own research.)

So, it goes behind just doing one’s homework; it also involves (what I call) becoming a “student of prostate cancer,” learning the language, self-advocating, and sharing in the decision-making.

As for that extra 2%, I would take that small change - with the full understanding that by incorporating a robust resistance-training exercise program, that I could minimize/avoid most of the common ADT side-effects. (And being a gym-rat myself, that’s what I did.) Quality of life was equal priority for me as was successful treatment.

I’ll take that 2% using the ADT (which I did), plus the few % with a rectal spacer, plus the few % with a full bladder, plus the few % with an empty bowel, plus a few % monitoring my diet, plus, plus, plus……..during and after treatment those small plusses add up to something meaningful.

There’s a study that Dr. Scholz cites about ADT providing little benefit for Gleason 7. (It might be the same one you’re referring to, I don’t know.) When I listen to that Scholz video, he refers to Gleason 7 as well as “intermediate disease,” but never mentions whether that’s 3+4 or 4+3 (or favorable/unfavorable). Similarly, when I located the literature on that study he was citing, it also refers to Gleason 7 as well as “intermediate disease,” but never mentions whether that’s 3+4 or 4+3 (or favorable/unfavorable). So, depending on how weighted that study was towards 3+4 rather than towards 4+3 might explain the small % survival increase of using ADT.

(Ultimately, I had 28 fractions of proton radiation + 6 months (two 3-month injections) of Eligard. The radiation treatments were relatively uneventful; the Eligard was a 9-month annoyance.)