Should you get a bone test if only on ADT for 6 months

Posted by pamperme @pamperme, Aug 8 12:46pm

I am 73 and was on Orgovyx for six months and had 38 sessions of radiation treatment for a reoccurrence of prostate cancer. At 7 weeks off of Orgovyx I am at 214 tester one compare to 567 before treatment. Should I be asking for a bone density test, my Dr has not bought the issue up.
Best wishes to all
Timmy

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Profile picture for gently @gently

Timmy, yes. it's an easy test. Radiation, also, can negatively affect bone marrow where the cells that build bone originate.

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@gently thank you, I did not think of that. My Platlets have gone low when tested at 6.5 weeks after radiation. They were in the acceptable range at 3 weeks after radiation.
Best wishes
Timmy

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Profile picture for pesquallie @pesquallie

@climateguy

I know of no one who had the tests you listed. Everyone I know got radiation or surgery with only a biopsy and PET scan. All also got ADT for 18 or more months.

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@pesquallie
Actually, everybody supposed to get monitoring For these things. I’ve had them pretty regularly
DEXA (Bone mineral density) scan before getting ADT. And every 2 years while on it
A lipid test for HDL, LDL triglycerides. ADT can raise your HDL and LDL and require a statin
Plasma glucose levels = Blood sugar levels. ADT can give you diabetes or prediabetes
Calcium and vitamin D - Both are recommended for anybody on ADT for bones

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Gleason 9 diagnosed in August 2024. I was on Orgovyx for 20 months, ending in April 2026. Twenty-five sessions of IMRT. PSA presently less than 0.04. 74 years old. Presently taking Centrum 50 Plus multivitamins and Omega 3 fish oil daily. I'm debating whether or not to take Calcium Citrate supplements because I had a kidney stone removed four months ago and still have a non-obtrusive small stone in the other kidney.

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My experiences while on Firmagon, which doc initially said would be 6-12 months.

No offer for a DEXA was made by my COE care team. After first one month shot of Firmagon I was watching a PCRI 8 hour long video for their September 2025 conference in Los Angeles. Within the video one oncologist said that ANYONE that will be starting on a course of ADT should have a DEXA. So I asked the oncologist taking care of me about that. His reply paraphrased was since I asked they would do it. But that Medicare may not pay the test cost. Told him I didn’t care and wanted a scan. It came back showing that I ALREADY HAD osteoporosis. Visited and Endocrinologist and she did a zoledronic acid infusion. Also taking vit D and Calcium. And three hours a week doing resistance weight exercises.

Point is that you will need to advocate and press the care team to have this test done. Things could have turned out really bad for me, and it was just luck to a degree that helped.

I pulled the plug on Firmagon after five injections. Last one was mid February. Mid June checkup had me at undetectable levels of both psa and testosterone. So my five months of Firmagon (started October 2025) has at this point turned into 10 months and counting. So glad I stopped when I did.

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Profile picture for clevelandguy @clevelandguy

@monte09
Hi,
If your PSA is starting to climb after several readings I would say a PET scan would be the next step. Since you did have radiation you will have some live Prostate tissue so your PSA test score could bounce around a little the settle down to a average level.

Dave 3+4

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@clevelandguy Thanks for comments. my PSA in May was .014 and I am due to get another test next week prior to 1 year Radiation Oncology follow-up. I was told that the side effects with Hormone treatment would be 10% compared to prostate removal or implants. That has not been the case...it's more like 40-50% side effect issue. The fact that after the 3rd shot, my hips started hurting was very troublesome and disabling to normal life...hard to walk. The bone density completed at mid-treatment was normal but Orthopedic Surgeon says Bursitis could be started. I am still going to request a PET scan because quick onset of severe side effects in bone and skin itching after 3rd shot is troubling. I was told prior to being diagnosed for Prostate Cancer that the increased PSA score after 70 years old is natural....then I was diagnosed with an aggressive Aden Carcinoma Cancer. I question everything.

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Profile picture for Jeff Marchi @jeffmarc

@monte09
You don’t mention your current PSA level. If it’s undetectable Or real low, then insurance may not pay for a PSMA pet test. That is what you want however, if you have hip pain. They could do a bone scan just to see if they can find a metastasis with that, The PET scan is better, but they can do the bone scan with a low PSA. They can also do a CT scan to see if there’s any changes from a previous scan. That is sort of standard to do every six months for somebody that has had prostate cancer treatment.

If you are going to continue to get Lupron shots, you should ask to switch to Orgovyx, A daily daily pill you take, and it may not have the same side effects.

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@jeffmarc Thanks Jeff for your comments. I had a bone scan...it was normal. As I discussed with "clevelandguy", the side effects after shot 3 came on strong and disabling. I have done some research and there is a possibility that cancer cells become immune to hormone meds and seek other sources to survive. Per my Urologist, my cancer was very aggressive and climbed very fast until my first hormone shot. I am going to continue to look at all testing options available. Had my PCP intervened two years prior when PSA started climbing, the last 18 months of discomfort and doubt could have been avoided or less intrusive.

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Yes. I was only on six months of ADT but it took two years (including the six months) before my testosterone came back and I developed osteopenia/osteoporosis on my DEXA scan. After being initially terrified of it, I've been taking weekly Fosamax plus continuing to do lots of weight bearing exercise. We'll see if things improve at the 6 and 12 month mark.

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Profile picture for monte09 @monte09

@jeffmarc Thanks Jeff for your comments. I had a bone scan...it was normal. As I discussed with "clevelandguy", the side effects after shot 3 came on strong and disabling. I have done some research and there is a possibility that cancer cells become immune to hormone meds and seek other sources to survive. Per my Urologist, my cancer was very aggressive and climbed very fast until my first hormone shot. I am going to continue to look at all testing options available. Had my PCP intervened two years prior when PSA started climbing, the last 18 months of discomfort and doubt could have been avoided or less intrusive.

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@monte09
My cancer became resistant to ADT after 2 1/2 years and my PSA started rising. That’s how you know if you have become resistant. If your PSA isn’t rising, then you are not. I then went on an ARPI drug, and it kept it under control, Though I needed to go on Darolutamide Three years later to really get my PSA to stay undetectable.

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Profile picture for scottbeammeup @scottbeammeup

Yes. I was only on six months of ADT but it took two years (including the six months) before my testosterone came back and I developed osteopenia/osteoporosis on my DEXA scan. After being initially terrified of it, I've been taking weekly Fosamax plus continuing to do lots of weight bearing exercise. We'll see if things improve at the 6 and 12 month mark.

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@scottbeammeup

Wow, that's a long time Scott. I finished my last Eligard October '25 and I'm still a sweaty mess most of the day! haha How long did it take for the side effects to go away?

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Profile picture for Jeff Marchi @jeffmarc

@monte09
My cancer became resistant to ADT after 2 1/2 years and my PSA started rising. That’s how you know if you have become resistant. If your PSA isn’t rising, then you are not. I then went on an ARPI drug, and it kept it under control, Though I needed to go on Darolutamide Three years later to really get my PSA to stay undetectable.

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@jeffmarc Thanks Jeffmarc. I will know more after upcoming PSA test. I just wish there was a better flow of medical information and expectations of side effects to lower the anxiety.

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