ADT, maybe not? Anyone opted out of ADT?

@heavyphil
Because of my BRCA2, my oncologist says I shouldn’t let my testosterone Above 50, So I had to go back on ADT.

Didn’t have a rise in PSA at all, Just testosterone went up pretty quickly after being on ADT for eight years.

I am trying to get a 2nd opinion concerning ADT duration. I am 75 yrs old and just finished 8 weeks of external beam radiation therapy in Europe following a diagnosis of unfavorable 3+4 Gleason with no metastasis or ganglion involvement but some seminal vesicle involvement PSA 9. I had no symptoms was in great physical shape, but it showed up on an MRI and was confirmed by a biopsy an Pet scan. I am starting the 4th month of ADT and doing ok now that the radiation is completed. I have been advised to do 2 yrs of ADT. Is that standard in the United States? I am reading different studies questioning optimal duration. I exercise daily and always have but since starting ADT and the treatment have lingering lower back pain. I am not sure if it is ADT as I never had back pain previously. I also do not know how to find a good specialist to look over my treatment, the results and confirm or advise me as to other alternatives if necessary before I return for the second 6th month shot.

@lamer25
Were you told you are pT3b? With seminal vesicle invasion that is the normal stage.

Here are the USA guidelines for ADT.

You should notice that T3 requires at least 12 months. Not 24 months however, with your other low grade prostate cancer issues. Some doctors like to be more careful about spread.

Here are current NCCN Guidelines in 2025. They now suggest 0 (zero) months of ADT for low intermediate (GG2); 4-6 months for high intermediate (GG3), and 18-36 months for high risk (GG4 and 5). Actually, the footnote suggests ADT + abiraterone for T3b with lymph node involvement.
The meta-analysis suggests:
* 0 months for 1 intermediate factor (PSA 10-20, GG2 or 3, T2b-c)
* 6 months for 2 or more intermediate factors (PSA 10-20, GG2 or 3, T2b-c)
* 12 months for NCCN high risk (PSA >20, GG4 or 5, T3 or 4)
* undefined for NCCN very high risk (2 or more PSA >40, GG4 or 5, T3 or 4)

Keep exercising that defeats the fatigue from ADT.

@jeffmarc Well I guess all those charts showing negative outcomes for ‘older’ men don’t apply to everyone!😉

I had an intermediate risk prostate cancer diagnosis in July 2024 and decided on radiation treatment. ADT was recommended after treatment, but I declined. The attached YouTube video explains recent research. It is titled: Intermediate-Risk: Do You Need Hormone Therapy With Radiation? https://www.youtube.com/watch It is by Mark Scholz MD an oncologist that specializes in prostate cancer. (I also read the original research article that he discusses before making my decision.) No regrets so far. My PSA dropped from 14 before radiation to 6.83 three months later, to 4.18 after another six months to 2.12 just 13 months after radiation.

I was GG2 and did Proton without ADT. I was one positive core away from unfavorable so I did a decipher. Came back at .30 so RO and I proceeded without. 11 months past completion. PSA has been a wild ride. 6 weeks ago I was at 9.6 and assuming failed treatment. Yesterday’s PSA came back at 3.86. Dropping at 1 point per week. I think ADT would have masked this roller coaster. Some studies say bumps infer less BCR. We will see.

@neilmartin
I know of people that have taken three years before their PSA dropped to the lowest point after having radiation. This is unusual, but it happens.

@climateguy
You need to be careful when reading the Duke report because they use the term hormone when speaking of testosterone which technically is a hormone. It is confusing but based on the quote below they are saying that high doses of testosterone are best for aggressive difficult to treat prostate cancer.

"In recent years, clinicians have begun treating patients with late-stage, therapy resistant prostate cancers using a monthly, high-dose injection of testosterone in a technique called bi-polar androgen therapy, or BAT. The inability to understand how this intervention works has hindered its widespread adoption as a mainstream therapeutic approach for prostate cancer patients.

For the whole article see: https://corporate.dukehealth.org/news/study-solves-testosterones-paradoxical-effects-prostate-cancer

I was the same boat PSA 8.5 Gleason 4 + 3 dechipher score .59 Had a prostate removal. Four months PSA

was .19 3 months later .85 PETSMA showed 1 lymph node on the pelvic bone. Now took ADT shot today

4 weeks till radiation 5 weeks 5 days a week. Hope that its done after that

@wilke333
This recurrence is pretty quick.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

I went 3 1/2 years after surgery before my PSA started rising and I had radiation. I was a 4+3, but had BRCA2, which makes my cancer much more aggressive. Besides that factor, it still took 3 1/2 years not months.

Your cancer is very treatable, but a cure is not in the picture. The best option is you will be in Remission for a while. Because it came back so quickly, they may want to continue ADT, To prevent yourself from becoming Castrate resistant, you should also ask to be on an ARPI.

You should speak to your doctor and ask why they think your cancer reoccurred so quickly.

During surgery, they frequently remove lymph nodes. Did they do that in your case? Something else to ask the doctor.

You could get genetic testing to find out if it could be a factor. Does anybody else in your family have cancer? You can get it here for free, takes 2 to 3 weeks to get the results and a genetic counselor will call you. They will send you a kit that you return in the mail. You have to live in the USA to get this test for free.

Prostatecancerpromise.org