Proton Beam Therapy - Comments on adding ADT? Yes or No?

79 years old when biopsy detected prostrate cancer all on right side of prostrate. GS 7(3+4) on 6 samples. Had a genetic test that listed severity as low high risk. Risk of metastasis in 5 years 13% and risk of dying in 10 years 9%. I had a six month Eligard shot in November 2020 and 44 proton beam treatments at Mayo in Arizona. Current PSA < 0.1 and testosterone 12, with the low range being 175 mine is very low. I still have severe hot flashes and testicles have shrunk to about 1/3 normal size. I have belly fat that I can’t seem to get ride of. Currently 155 lbs and my guess is 2 lbs could be belly fat.

My opinion about the ADT is that it should have demonstrated benefits since the side effects are long lasting.

I had similar numbers but 6.5 psa and 71 years old. I knew my tumor was new thus I decided not to do ADT. I had twenty sessions and I am 8 months out from last treatment and doing fine. Hope this helps

Hi Kansascityhusker. Have you talked to your radiation oncologist about this? Not sure you can get ADT after you start radiation, if you've started. I was told that ADT reduces the size of the prostrate which makes the radiation more effective. ADT also attacks cancer cells that might be outside the prostrate. I had to wait 2 months after taking ADT before starting radiation. I think your doctor is probably looking at risk-benefit issues. Using ADT reduces the risk of the return of the cancer. Ask your doctor about the research.

Thank you rcs! Greatly appreciate you sharing your experience!

I'm not sure you can start ADT after you have started your radiation. For my EBRT I was put on Lupron 2 wks before starting the treatments? Maybe it's different for Proton?

I did 3 months on orogovyx. 2months on before starting radiation. All the studies indicate srt is more effective if u do adt prior.

FWIW, the Prostate Cancer Foundation states that "ADT has never been shown to extend life if it’s given too soon". Also, page 34 of their "2021 Patient Guide" indicates (my interpretation) that the treatment options for someone with GS7 (3+4) Grade 2 (Favorable Intermediate Risk) include surgery OR radiation therapy; while someone with GS7 (4+3) Grade Group 3 (Unfavorable Intermediate Risk) include radiation PLUS short-term ADT or, surgery +/- post-op radiation. For High Risk (GS8 - Grade Group 4) and for Very High Risk (GS9 or GS10 - Grade Group 5) cases, ADT appears to always be recommended. Remember, these are just guidelines so do your own research and be sure to talk to your radiation oncologist since each case can be unique.

At 78 with a Gleason of 4+3, my radiation oncologist at Mayo recommended 44 sessions of proton radiation and 18 months of Lupron shots starting 60 days before radiation. My recollection was chances of spiking the cancer would be 8-10% higher with Lupron. Yes, there are side effects: hot flashes, tiredness, and sexual dysfunction, but I can live with those to beat cancer. I exercise, eat right, and have a positive outlook. I trust my Mayo oncologist and take his advice. 1+ year after completing radiation, all my test results look excellent. Good luck to you,

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- Prostate Cancer Foundation about ADT: https://www.pcf.org/c/adt-what-you-really-need-to-know/

Thank you both for posting this. Very straightforward and useful.