Is hormone therapy necessary with radiation?

I just posted on my old thread and I just noticed this one.

Right now my RO wants me to stay off any and all ADT he said he wants to see what my PSA does. He said I've looked over your labs and said with all the clear margins, lymph nodes and seminal vesicles from my RP last year it could possibly be the only recurrence you'll have. My concern is that the final pathology was T3a and from what I've looked up that means it had broke through before it was removed why it didn't attach itself in the pelvic area no one knows or why it went for my humerus bone no one knows for sure. He said if my PSA rises again we'll do another PET scan and see if we can find it. He said if it doesn't show up on the PET scan the most logical place it would be is the pelvic bed and we can radiate there. He said if it levels off and remains stable that he wouldn't recommend ADT. Yes he said ADT can help keep it in check but also can mask it to a degree. He said the quality of life can be severely affected in some men once you start ADT. I see my Urologist this Thursday for what I assume is my first PSA test since finishing my 5th round of SBRT Monday. There's still some pain in that bone but it's not as bad as it was. He said if my Urologist really tries to push the ADT on me to have him call him directly. They've been in communication with each other already about my case.

surftohealth88 wrote: Yes, we have members such as @jc76 here that did that with gleaosn 8 and with good results.

That would be me or at least I hope I can get by without ADT.
Here's my early 2025 Biopsy results.
1. Prostate, lesion 1 right posterior lateral mid, needle core biopsy:
- Prostatic adenocarcinoma, Gleason score 4 + 3 = 7 (Grade group 3), involving 70% of one core.
- Prostatic adenocarcinoma, Gleason score 4 + 3 = 7 (Grade group 3), involving 40% of the second core.
- Gleason score 4 pattern accounts for approximately 90 % of the tumor.
2. Prostate, right base, needle core biopsy:
- Prostatic adenocarcinoma, Gleason score 4+4=8/10, (Grade group 4), involving 1 of 1 core, accounting for approximately 10% of total volume of biopsy tissue.
3. Prostate, right mid, needle core biopsy:
- Benign prostatic tissue.
4. Prostate, right apex, needle core biopsy:
- Benign prostatic tissue.
5. Prostate, left base, needle core biopsy:
- Benign prostatic tissue.
6. Prostate, left mid, needle core biopsy:
- Benign prostatic tissue.
7. Prostate, left apex, needle core biopsy:
- Benign prostatic tissue.

@wheel1 Everybody’s after the same pot of gold - YOU!
How is it that with all the crying and hand wringing about lower reimbursement, insurance woes, higher staff salaries, NYU Langone has purchased 45 acres in Melville, LI for $135M and is going to build a $1B+ hospital campus?? They already blanket LI…
They KNOW they’re gonna get it back 10 fold from the tens of thousands of different, specialized, tailored procedures they’ll do every year. It is a BIG business!!
Phil

@im62at2024
Unfortunately, the only thing you provide is your T3a. In order for us to really Comment about what’s going on we need to have information.

What was your Gleason score? What was your PSA before you were treated? Did you get a decipher test or any equivalent test? That could really tell you what your chance of reoccurrence is and whether or not you need ADT.

I do realize that it has broken out of the capsule, but there’s no evidence that it spread. They didn’t find anything in the lymph nodes.

Were any of these things found in the biopsy or MRI intraductal, ductal, large cribriform, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive. I suspect your doctor doesn’t think any of these occurred.

Your radiation oncologist may be right, And the PSA will show what’s really going on.

@surftohealth88
Thanks for the encouragement, Mrs. Surf. I definitely will keep you all posted once things get moving.
Sorry to hear of your delayed responses in CA--I hope you hear soon.
I now have another "second opinion" appointment in MSK in NYC on 6/19 (this time with an MO); I was hoping for a Telehealth appt since I live in DC, but they said they aren't licensed here.
Honestly I was surprised at how quickly I got appointments--maybe 3 days or so to get a response and the appointments were for about 7-10 days out.

@jeffmarc
My most recent post-op Gleason scores from early 2025 are two comments above yours. Here was my Gleason scores from 2021. I hope this helps because I don't have access to much more info than this.

1. Prostate, "Les 1 Rt posterior lateral peripheral zone", needle core biopsy:
-Prostatic adenocarcinoma, Gleason score 3+3 = 6, grade group 1, involving 10% of 1 core
2. Prostate, right base, needle core biopsy:
-Prostatic adenocarcinoma, Gleason score 3+3 = 6, grade group 1, involving 5% of 1 core
3. Prostate, right mid, needle core biopsy:
-Benign prostate tissue with atrophy
4. Prostate, right apex, needle core biopsy:
-Benign prostate tissue with atrophy
5. Prostate, left base, needle core biopsy:
-Benign prostate tissue
6. Prostate, left mid, needle core biopsy:
-Benign prostate tissue with focal acute inflammation
7. Prostate, left apex, needle core biopsy:
-Benign prostate tissue

Clinical Information
Diagnosis:
R97.20 - Elevated PSA [ICD-10-CM]

Here is my "Oncotype DX Genomic Prostate Score*" from 2021. As far as I'm concerned it couldn't have been more wrong. Also attached is all my PSA history.

@im62at2024
Looking at your 2025 biopsy what your doctor has recommended makes sense to me. I started off with surgery and had no ADT for 3 1/2 years after. I was a 4+3. Then my PSA started rising so they gave me a 6 Month Lupron shot And two months later, I had salvage radiation. No more ADT until my PSA started rising again.

I didn’t find out until many years later that I had BRCA2 and that is why it keeps coming back. If I didn’t have it, the first surgery might have ended the whole thing. That’s where you’re at today. A 4+3 With the possibility that you won’t have a reoccurrence. If you want to get monthly blood tests and see if The PSA start starts coming back up. It may not.

I am trying to get feedback from others who have been through salvage radiation plus ADT, especially regarding how long to stay on ADT. Here is my prostate cancer history:

I was originally diagnosed with prostate adenocarcinoma, clinical stage cT1c, with a PSA of 14.97. My biopsy Gleason score was 4+4. I had a robot assisted laparoscopic radical prostatectomy in January 2025.
Final pathology after surgery confirmed prostate adenocarcinoma, Gleason score 4+3, Grade Group 3, pT3aN0M0, AJCC Stage IIIB. Margins were negative, lymph nodes were negative, and there was no seminal vesicle involvement.

However, there were several adverse features, including lymphovascular invasion, perineural invasion, and focal extraprostatic extension in the right posterior dominant nodule. My Decipher score was high, around 0.84 to 0.85. After surgery, my PSA did not become undetectable. My post prostatectomy PSA readings were:

Before surgery PSA: 14.97
April 2025: 0.11
June 2025: 0.15
Later readings gradually rose to around 0.17 to 0.18 before salvage treatment.

Because the PSA persisted after surgery and gradually rose, my doctors treated it as likely residual microscopic prostate cancer, even though imaging did not show visible metastatic disease.

I started Orgovyx, on October 14, 2025. I started salvage radiation on November 20, 2025, after about five weeks on Orgovyx. I completed 39 radiation treatments after surgery.

My current bloodwork after radiation and while on Orgovyx shows my PSA is less than 0.01. My testosterone on April 6, 2026 was 9.2, so Orgovyx is clearly suppressing testosterone.

My doctor would prefer I stay on Orgovyx for at least 18 months. He even mentioned 24 months. I am trying to understand whether extending closer to 18 months provides a meaningful benefit in a case like mine, given the high Decipher score, persistent PSA after surgery, and adverse pathology, versus the side effects and quality of life impact of longer ADT.

Because my PSA is currently being measured while my testosterone is extremely low, I understand that I may not know my true post radiation PSA behavior until testosterone starts to recover after stopping Orgovyx.

I would be interested in hearing from others with similar pathology, persistent PSA after prostatectomy, salvage radiation, and ADT. How long did you stay on ADT, and what factors helped you decide between 6, 12, 18, or more months?

I am only 58 years old so I worry the damage Orgovyx is doing internally. I am active, healthy, 6' 174 lbs. Side effects really are minimal. I see a little loose weight gain around my stomach, lost some muscle tone and get the hot flashes when I sleep. I would prefer to stop taking Orgovyx if it doesn't improve my survival outcome by much.

@tj1967
I have run into a lot of people with equivalent issues to what you have. I do attend nine advanced prostate cancer meetings every month So I hear a variety of cases.

You have a very aggressive case of prostate cancer. There is just no doctor that would recommend you’d be on ADT for less than 18 months.

You have a high Gleason score. You have a pT3a, EPE, A PSA that never became undetectable after surgery, Which is a major issue. You can stop Orgovyx sooner than 18 months, But your PFS (progression free survival) is probably going to be very short.

It would make a lot of sense for you to attend an ancan.org Advance prostate cancer weekly online meeting. They’ve been helping people 15 years with prostate cancer treatment questions. They’re very experienced with working with people with your level of cancer. I know what they would say, 18 to 24 months for sure. They have been seeing people with your level of prostate cancer after treatment and those that survive the longest stay on ADT.

I got prostate cancer at 62 and had surgery, 3 1/2 years later, it came back and I had salvage radiation. 2 1/2 years after that, it came back and I went on ADT. I’ve been on it for eight years now. Yeah, it gave me a little bit of a belly, but I’m 6‘4“ tall and weigh about 189. I walk on the track a mile twice a day (I was running, but my Orthopedics said stop because of my new hip), And I go to the gym three times a week and work on my muscles, So I don’t lose any more muscle strength. I also take a bone strengthener, Though I just finished and what I took will last a year or more. I am 78 and You would never guess I had prostate cancer and was on ADT for so long.

If you’re keeping good shape and exercise, ADT won’t have a major effect on you long term.

If it continue to have a problem with hot flashes at night, there are a lot of solutions, Come back and ask for help.

I haven't posted for awhile; my story is many posts back in this thread. In short, I have aggressive cancer that has returned after RALP in 9/25 and I am beginning treatment this week.
I started radiation therapy for my pelvic region and lymph nodes today--smooth start.
I met my medical oncologist yesterday for the first time (Dr Paller at J. Hopkins) and really liked her. She agreed to my request for the Estradiol patch (which I started today) and then we discussed Nubeqa v Zytiga (with prednisone). I ultimately decided on Zytiga because: 1) The study (NRG-GU006 / BALANCE) showing significant benefit of using a second drug in addition to ADT for patients in the Luminal B subgroup (like me), used Zytiga as the second drug; 2) She preferred to keep the Nubeqa in reserve for later recurrences (consistent with the NCCN guidelines); 3) There are mixed thoughts about which drug has worse side effects (including in this thread).
I will start these drugs tomorrow.
I still am on bicalutamide; it dropped my PSA from 0.215 to 0.133 in one week--not bad. I will stop the bical when I switch to Zytiga. I had hoped to start treatment before reaching 0.2, as that leads to better outcomes, but 0.215 is not that bad.
Thanks to all of you for your encouragement and interest.