1. < Prostate Cancer

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

Posted by kansascityhusker @kansascityhusker, Oct 5, 2021

So I am very early into my Proton Beam Therapy to treat my prostate cancer. My cancer was evaluated as "intermediate risk" -- with a Gleason Score of 7 (4+3) and PSA of 7.9. I am 68 years old. I have had 4 sessions of my 28 scheduled Proton Therapy sessions. I, initially, decided to turn down 6 months of ADT -- even though it was recommended. I did that primarily because I had heard that with my numbers I might not need ADT. Wondering if maybe I should reconsider? Anyone have any experience either pro or con taking 6 a month dose of ADT with their Proton Therapy to treat their prostate cancer? Appreciate any outcomes or experiences that anyone can share.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

melcanada | @melcanada | Feb 22, 2023
In reply to @melcanada "Same here They took me off Zolodex and 2 yrs later had to have radiation to..." + (show)
@melcanada

Same here They took me off Zolodex and 2 yrs later had to have radiation to L2 lumbar Back on Zolodex for 2 year but now Xtandi is added

$4k a month but covered in Canada as I'm 78 over 65

Prayers

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Adding this FYI
https://www.drugs.com/medical-answers/xtandi-enzalutamide-stopped-working-3554759/

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mikewo | @mikewo | Feb 22, 2023
In reply to @bandit11 "Gleason grade 4+3 with cancer contained in prostate. PSA level was 8.6 for 74 year old..." + (show)
@bandit11

Gleason grade 4+3 with cancer contained in prostate. PSA level was 8.6 for 74 year old at date of cancer diagnosis. Decipher score of 48 and PSMA pet scan confirmed no spread. Decided against four months of hormone therapy due to potential side effects both physical and mental. Decision was related to quality of life in last remaining years rather than quantity of life. Proton therapy completed nine months ago and PSA level continues to decline in line with expectations. Prior to decision, read extensively about pros and cons of hormone therapy and made decision I felt was best for me. Obviously, time will tell.

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I am in the same boat as you. I am 73 and a half and had a 30-core trans perineal biopsy and 5 were from the area of the lesion were positive. Some were 3-3 some were 3-4 and two were 4-3. PSA 2.9 and the PSMA says it was all contained to the prostate. RO wants 6 months of ADT and from what I have read it makes almost no difference in men over 70. So, I have been mulling over what to do. Radiation for sure but 5 or 28 sessions and maybe a 3-month shot rather than 6 months just to hedge my bet.

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1 reply
bandit11 | @bandit11 | Feb 23, 2023
In reply to @mikewo "I am in the same boat as you. I am 73 and a half and had..." + (show)
@mikewo

I am in the same boat as you. I am 73 and a half and had a 30-core trans perineal biopsy and 5 were from the area of the lesion were positive. Some were 3-3 some were 3-4 and two were 4-3. PSA 2.9 and the PSMA says it was all contained to the prostate. RO wants 6 months of ADT and from what I have read it makes almost no difference in men over 70. So, I have been mulling over what to do. Radiation for sure but 5 or 28 sessions and maybe a 3-month shot rather than 6 months just to hedge my bet.

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Hard decision to make on ADT. My fathers family has quite a bit of dementia which was a major factor for me. Also, a consulting radiologist with national credentials estimated that ADT , in MY specific circumstances would improve life expectancy by 2 to 5 percent. Treating radiologist was much stronger in recommending ADT. Learn all you can, make a decision and don’t second guess yourself! Best of luck.

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rcooley36 | @rcooley36 | Feb 23, 2023
In reply to @colleenyoung "@rcooley36, I hope you saw all the helpful comments from fellow members. Did you decide to..." + (show)
@colleenyoung

@rcooley36, I hope you saw all the helpful comments from fellow members. Did you decide to go with hormone treatments after radiation? How are you doing?

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Thanks for looking in on my post. I chose and completed the five treatments, high dosage proton beam radiation therapy combined with six injections of Eligard at three month intervals (Phoenix hospital). I am still debating continuing the hormone therapy based on side effects to date. Specifically, after the first injection, I am experiencing increasing fatigue, lower back pain and increasing sessions of unbalance/dizziness. These side effects are in addition to the text book issues of zero libido, etc. I have a follow up with the ONC Radiation doctor on March 28th and will come to a conclusion after this visit with him. I find the Mayo Connection posts to be very helpful. TKS

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rcctiger | @rcctiger | Feb 23, 2023
In reply to @jimcinak "I had a Gleason score of 4+4; the cancer appeared to be contained in the prostate..." + (show)
@jimcinak

I had a Gleason score of 4+4; the cancer appeared to be contained in the prostate with no obvious 'puching' of the outer membrane. I chose PBT at Mayo/Rochester. They suggested a short course of 4 months of ADT (Lupron, I think). My understanding was the reason for the ADT was to add to the possibility that injured or damaged prostate cancer cells would not have the 'food' of testosterone.
I had reduced libido, increased ED and perhaps increased emotional lows (hard to distinguish ADT vs the middle of the pandemic).
Since then my PSA has stayed about .02.

ADT certainly has benefits depending on individual diagnoses and circumstances, but I (and others, I believe) might have benefitted with more coaching about the need for muscle strengthening /maintaining exercise and maybe emotional coaching. It was certainly 'different' to have my libido hit zero. Since the ADT shot has worn off, I've had some recovery of libido and ED. Not sure about muscle loss.

Hope that helps.

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@jimcinak, my prostate cancer is identical to yours except you were at Mayo Rochester two years before me.

4 +4 Gleason, Space Oar inserted in Feb. 2022, 5 sessions of PBRT in Mar. 2022. The only difference was that I was on Lupron for 14 months. Completely off Lupron as of Nov. 13th and waiting for side effects to wane. Mostly sleep issues and low energy. By April/May I hope to be back close to my normal self.

That being said, I wouldn’t change a thing regarding my treatment. Mayo is the best place to go for treatment of prostate cancer. Very appreciative and thankful for the care I received.

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