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Has anyone done Proton without Hormonal Therapy (ADT)?
Prostate Cancer | Last Active: Mar 30, 2023 | Replies (24)Comment receiving replies
I had proton without ADT. I was an otherwise healthy, very active 74 year old who did not want some of my last good years potentially ruined by ADT. If my life expectancy was shortened somewhat but quality was increased, count me in. One of the radiologist that I consulted with estimated that while deleting ADT might result in a 20% worse outcome, perhaps a 15% better outcome would occur from avoiding all the other health impairments that could occur from ADT. One of the specific considerations for me was the amount of dementia in my family on my fathers side. It is important to state that this radiologist estimate was for my specific case and personal considerations!
I did all the recommended things( bone scan, mri, PSMA pet, decipher and pathology second opinion) as well as consulted with urology oncologist, photon radiologist and two proton radiologists. My Gleason was 4+3 (2 cores) and 3+4. ( 3 cores) out of 10 samples. My PSA was 8.9. Post-treatment PSA was 2.9, 2.3,4.9 ( spike that happens sometimes) and 1.7. I completed proton treatments a little over a year ago so only time will tell if this was the right decision but you make the best decision for you and don't look back.
Replies to "I had proton without ADT. I was an otherwise healthy, very active 74 year old who..."
I just finished the five-treatment proton at Mayo Phoenix. I am two months shy of 74 and I am very similar to you. I had Gleason 4-3 in two cores and Gleason 3-4 in three cores all from the same location of my 120 gm prostate. I had a 30 core MRI fusion guided transperineal biopsy. My PSA was 2.9 and my original MRI showed a 7mm lesion. My three-month post radiation PSA was undetectable. I also did not take the Lupron shot because I had been on TRT since 2008 and when I stop applying the Androgel I go castrate in 60 hours. My radiation oncologist didn't believe me, and he wanted to jab me so bad he could taste it from my opinion before I left the hospital during our initial meeting. He tested me about a month later and I was at 12 ng/dl. All my research shows that ADT makes almost no difference in men over 70 to BCR or overall survival. Why did I stop my testosterone gel? Just hedging my bets, I guess, and I didn't need to take a drug to get the same results. I plan on going back on the TRT in September after visiting my nine-month-old granddaughter. Don't want any testosterone rubbing off on her.
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I like that mentioning better outcomes by skipping, it is only fair. I have brought up a half dozen papers on ADT and stats are not me field but I can say one thing they never mention is deaths from obesity, or deaths from brittle bones and you fall down steps and need hip replacement and stroke out during surgery. All that is missed in every paper that I looked at. Plus stats is a field where differing stat methods show differing outcomes too because separating real results from noise is not so trivial sometimes, though papers are peer reviewed in all journals doesn't mean multiple methods were run to be sure.
Of course if your testosterone is on the moon high then ADT might be handled well and just brought down a bit during ADT then it comes back up, but most of us are not teenagers last time I checked.