About to start treatment with Proton, question about ADT

When I was 65, 13 years ago, I had to have 8 weeks of salvage radiation. They gave me a six month Lupron shot And I didn’t realize that it had side effects and I didn’t notice any.

My brother at 75 had 5 sessions of SBRT radiation And a six month Lupron shot And he did have hot flashes that lasted for about nine months after the Lupron shot had expired. He noticed no other side effects.

If you are going to have ADT you should request Orgovyx Instead of an injection. Orgovyx has fewer side effects and after you stop taking it, your testosterone comes back quicker. While I had really major hot flashes on Lupron, I get very mild ones on Orgovyx, and I get very few.

I have been on ADT for eight years. A lead a normal life And no one has any idea I have prostate cancer unless I tell them. I do run on the track twice a day, 1 mile each time, and go to the gym three times a week. The first four years I was on ADT I didn’t do any extra exercises. My lifestyle kept me strong.

ADT can shrink the metastasis and make the radiation more effective. It will also stop it from growing since you usually get it a couple of months before you actually have radiation.

You have a very treatable case of prostate cancer. Don’t get too worried, between the treatment you plan on having and what is available if it comes back, you’re going to be around for decades.

I don't keep up on the stats like @jeffmarc does, but, my RO said there was a 3%-5% chance of a better outcome with ADT vs without. That was in 2021 and things change quickly in the treatment of PC.

I'm a hit it with everything we can type of guy, I went on ADT for two years, it's a pain for sure, but doable.

off to the gym, Best of luck to you!

A lengthy response (that addresses all of your questions/comments) —>

Somewhat similar to your situation, I was diagnosed at 56y/o with low-grade, localized disease and was on active surveillance for about 9 years before my Gleason 6 became a Gleason 7(3+4).

During the last few of those 9 years, I obtained referrals to specialists in the various treatments and evaluated each treatment regimen to determine what was best for me, so that when/if the time came that I needed to make a treatment decision, I was fully informed and prepared to pull the trigger.

Regarding your recent MRI:
> Did the MRI report mention the terms extracapsular extension, seminal vesicle invasion, or perineural invasion?
> Did you get a 2nd opinion on the MRI scan?

Regarding your recent biopsy:
> What % were “4” and what % were “3”?
> Did the biopsy report mention the terms cribriform pattern or intraductal carcinoma?
> Did you get a 2nd opinion on the biopsy tissues?

You mentioned that “…. I have now had a PSMA PET scan, and it was clean. They couldn't even get a strong result from the primary site, which I was told was not unexpected.”
> what were the SUVmax scores mentioned in the PSMA PET scan report?

Regarding the proposed 5 rounds of proton (that’s called Proton SBRT) - In this 2023 Mid-Year Prostate Cancer Patient Conference, Dr. Rossi mentions Proton SBRT with some caveats: https://www.youtube.com/live/WTqPnSRYtW4
—> Starting at timestamp 4:30:45: Proton SBRT

Similarly, I was offered the opportunity to be part of a clinical trial; I opted out of that opportunity, my attention being singularly focused in treating my disease. I did however chose to have my proton radiation treatment results submitted into a registry (https://clinicaltrials.gov/study/NCT02040467). Hopefully, it will help someone make a decision one day.

As for the use of ADT, NCCN guidelines do not recommend ADT for a 3+4=7 (see attached NCCN guidelines) unless there are other risk factors.

Most side-effects of ADT are easily minimized/avoided with resistance-training exercise. Here are just a few that I’ve bookmarked:

> Drs. Scholz and Moyad talking about exercise and hormone therapy (at a virtual PCRI conference): https://m.youtube.com/watch

> A paper on The Benefits of Exercise During Hormone Therapy: https://static1.squarespace.com/static/54c68ac6e4b06d2e36a4b8c9/t/55cb7275e4b0d97ae7ff60af/1439396469154/The+Benefits+of+Exercise+During+Hormone+Therapy_Insights+August+2015_PCRI.pdf

> A study about the benefits of exercise to counteract the adverse effects of ADT: (They describe a good resistance-training program): https://journals.lww.com/acsm-msse/fulltext/2023/04000/resistance_exercise_training_increases_muscle_mass.2.aspx

If you do what it takes, you’ll do very well with the hormone therapy side-effects - it’ll just be an annoyance; if you don’t do anything, hormone therapy can be your worst nightmare (like your wife indicated). For me, it was a walk in a park.

If it were me and I had any other risks beyond just a vanilla Grade Group 2, I would bump that treatment up a notch and take the 6 months of ADT (just out of caution).

As for my 28 sessions of proton radiation, it was a piece of cake. My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. And the short amount of time that I was gone each day for treatment were no different than any other time when I simply left to go shopping or to the gym.

As for the hormone therapy side-effects, they were greatly minimized by following a rigorous resistance-training program.

You have many good options available to you. Let the data guide your decisions.

@web265 I am on orgovyx 6 months in of 24, not really experiencing any side effects I’m also taking zytega for the duration as well not any side effects either. Stay strong and best wishes for a successful outcome.