PC spread to some lymph nodes; radiation, ADT. intermittent ADT

@kujhawk1978
Wow, Kevin. You are a straight shooter. I like that. We live in Canada and I think it is a bit more difficult to switch doctors. I have not asked for that but I am asking this doctor to be open minded and work with me. During our first meeting with her, (since our doctor was on maternity leave), I broached the topic of intermittent ADT. She dismissed it, immediately. She said he had some metastasis, why rock the boat? The cancer is in control, what is the problem with taking ADT? There are no real negatives. I said I believe there are negatives: loss of muscle mass, loss of bone tissue, no testosterone (which is cardio protective) and thus potential cardiovascular issues. This is where she said, you have to accept the bad with the good. And that is when I asked her if she had ever changed to intermittent ADT ? No, she has not. She prescribes it for life. So, we had a somewhat heated conversation on Friday and I asked her to work with us. My husband had a baseline blood test today. She has agreed that we can monitor it; blood tests every six weeks and she will consult with us in three months. But, I know she has put a fear in my husband... what if I get liver cancer? I said that we will monitor the PSA and no matter where it might appear in his body, the PSA will indicate it. I am no trying to risk my husband's life, but I am trying to help him get back some of his quality of life.

Warm regards

Glenda

@jeffmarc I am looking at the biopsy results. Cribriform pattern absent. Intraductal carcinoma absent. PSMA said extracapsular extension. Linear extension into the anterior aspect of the left seminal vesicle and periprosthetic fat, compatible with seminal vesicle invasion.

@gkgdawg Transdermal Estradiol is an alternative ADT drug. It is as efficacious and as safe as standard ADT drugs but does not cause bone deterioration and causes far less hot flashes, brain fog, etc. The main drawback cited is a higher rate of breast development than the standard ADT causes. The older a man is and the less obese, the less of a problem this is. Prophylactic radiation is also helpful. Transsexuals desiring breast growth are disappointed with what they get - 85% get a cup or nothing.

See this recently published study, https://www.nejm.org/doi/full/10.1056/NEJMoa2511781

Richard Wassersug has been taking tE2 for more than 20 years. He was interviewed on Dr Geo podcast recently https://www.youtube.com/watch

Paul Schellhammer, former President of the U.A.U. has been on it for almost 20 years. He was interviewed by Mark Moyad in a P.C.R.I video also recently https://www.youtube.com/watch

Estradiol Initiative is a good website to get more info https://estradiolinitiative.org/

@gkgdawg
Seminal vesicle invasion is a very aggressive issue. What is your T level, T3b It’s usually what they come up with when you have Seminal vesicle invasions. You aren’t a T4 are you?

Just trying to figure out why they would say three years, Seminal vesicle along with EPE is enough to ask for two years in the USA.

@kujhawk1978
Wow, Kevin. You are a straight shooter. I like that. We live in Canada and I think it is a bit more difficult to switch doctors. I have not asked for that but I am asking this doctor to be open minded and work with me. During our first meeting with her, (since our doctor was on maternity leave), I broached the topic of intermittent ADT. She dismissed it, immediately. She said he had some metastasis, why rock the boat? The cancer is in control, what is the problem with taking ADT? There are no real negatives. I said I believe there are negatives: loss of muscle mass, loss of bone tissue, no testosterone (which is cardio protective) and thus potential cardiovascular issues. This is where she said, you have to accept the bad with the good. And that is when I asked her if she had ever changed to intermittent ADT ? No, she has not. She prescribes it for life. So, we had a somewhat heated conversation on Friday and I asked her to work with us. My husband had a baseline blood test today. She has agreed that we can monitor it; blood tests every six weeks and she will consult with us in three months. But, I know she has put a fear in my husband... what if I get liver cancer? I said that we will monitor the PSA and no matter where it might appear in his body, the PSA will indicate it. I am no trying to risk my husband's life, but I am trying to help him get back some of his quality of life.

Warm regards

Glenda

@gkgdawg

Glenda

This forum is full of personal experiences with the side effects of systemic therapy.

I can't recall anyone having something positive to say.

Your doctor seems to lack currency in changing paradigm's in treating PCa.

Perhaps discussing ongoing clinical trials may help.
https://www.urotoday.com/conference-highlights/apccc-2026/168612-apccc-2026-update-on-de-escalation-strategies-in-mhspc-in-which-patients-and-when-can-we-stop-the-treatment.html

My husband had RP and he unfortunately had BCR 9 months later. His PC was found in several lymph nodes. He just finished RT and was prescribed Orgovyx and Nubeqa which he is supposed to take from 18 to 24 mos. and than stop.

I am pretty new to this phase of PC treatment but I never heard (so far) that patients are put on ADT indefinitely without being with distant metastasis. I might be wrong and I hope that @jeffmarc and the rest of ADT veterans will jump in here soon and share their wisdom.

Wishing you all the best and I am glad that you found this place and are trying to find good way forward for your husband. <3

@gkgdawg

Glenda

This forum is full of personal experiences with the side effects of systemic therapy.

I can't recall anyone having something positive to say.

Your doctor seems to lack currency in changing paradigm's in treating PCa.

Perhaps discussing ongoing clinical trials may help.
https://www.urotoday.com/conference-highlights/apccc-2026/168612-apccc-2026-update-on-de-escalation-strategies-in-mhspc-in-which-patients-and-when-can-we-stop-the-treatment.html