ADT, maybe not? Anyone opted out of ADT?

It is not unusual to fear the unknown. The side effects of ADT can be nasty but if it reduces your PSA to negligible, then it is worth it. After 11 years of on and off ADT, it is no longer working. After a year of advanced ADT my PSA is still high and the doctor seems determined to continue.
I would say to give it a try. If it is too much, you can stop it. I think chemo is the second treatment of choice.

@duberdicus
A moment my ADT stopped working and my PSA started rising. I was put on Biclutamide for 1.25 years and then on Zytiga for 2.5 years.

When ADT stops working, you become castrate resistant. Media survival for somebody that is casted resistant is two years. I became castrate resistant six years ago. I’m on Nubeqa Now and it has kept me undetectable for 24 months.

Standard of care calls for being on an ARPI as soon as you become castrate resistant. Zytiga is the preferred First drug, though it is hard on the heart And causes many side effects. I have found Nubeqa To have no noticeable side effects, And since it doesn’t pass the blood brain barrier, it doesn’t cause brain fog. I know a lot of people over at ancan.org That are using Nubeqa And are very pleased with its Side effects being minimal. A number of those people are using just Nubeqa Since it works quite well, even if you have testosterone.

Just some things to be aware about and to talk to your doctor about. If you have not been offered an ARPI, it would make sense for you to find a center of excellence to get a more informed opinion about your treatment.

My PSA was 13ish when I started treatment. I said a big NO to any kind of hormone therapy. The radiation side effects are bad enough.

@melvinw Thank you. Stay on top of it and continue to do your research. Each one of us has to be our own advocate. Good luck!

What is the alternative if PSA is rising by double every 6-12 months? The side effects of ADT varies by individual and type. Lupron and Orgovyx + Nubeqa has been very tolerable for me, whereas Zytiga was intolerable. As the saying goes “choose your medicine”.

PC therapies are a moving target as medical science accrues new data regularly. In the meantime, I am most comfortable sticking to standard of care guidelines outlined by the NCCN guidelines (the updated 2026 guidelines have recently been published). In my circumstance (Gleason 4+5) disease (progressed from 3+4) after 4 years on AS, I am willing to accept ADT recommendations in spite of the side effects. At 74 yr old an otherwise feeling well, I want the very best odds for long term disease control .

@rbtsch1951
Not sure you saw this message I posted

Some unique finding of the below study were:
1. All endpoints tailed off significantly after 9-12 months albeit with marginal improvements and fewer prostate specific deaths. High risk men had the least to gain beyond 12 months .
2. Increased duration, especially over 18 months, resulted in greater other cause deaths, albeit fewer prostate specific deaths. In the past only cardiovascular deaths were seen to increase with more ADT.
3. For very high risk men, the length of time should be tailored individually over 12 months.
4. NCCN risk groups may not be the best way divide treatment
5. Shared decision making should be included in determining how long to stay on ADT
6. For younger, healthier high risk men, there may be greater benefit to staying on ADT longer than 12 months.
https://jamanetwork.com/journals/jamaoncology/fullarticle/2841671

@jeffmarc Thanks Jeff for sharing that. Brand new and hot off the press, I see. I’m sure that’s why my RO is recommending 12-18 months rather than the longer duration (up to 36 mos) suggested by the NCCN guidelines (which are constantly evolving as new data accumulates).

@pesquallie

The Duke article opens with the statement: "Blocking testosterone production halts tumor growth in early disease, while elevating the hormone can delay disease progression in patients whose disease has advanced." If you are claiming, to someone who has just been diagnosed with early disease, that this research shows that "blocking testosterone production DOESN'T halt tumor growth", you are contradicting the Duke Health article. Perhaps I don't understand what you've written.

@jeffmarc Thanks for the article, Jeff…that study is a long time coming!
Quick question: What about your own situation? You are -ahem- not a young man and you have been on various forms of ADT for many years.
You’ve mentioned trying to go off ADT, but had a rise in PSA so had to resume…
Is it simply a case of choosing the lesser of two evils?
Phil