Continued hormone therapy? or not?

With a 3+4 they usually don’t recommend any ADT.

3.5 years after my surgery my PSA started rising, so I was given 8+ weeks of radiation. I was a 4+3. They gave me a six month shot two months before the radiation and none after. I didn’t have any more ADT until 2 1/2 years later when my PSA rose too much again.

Normally a 3+4 wouldn’t need additional ADT, But you had to have Radiation because your cancer had spread to more than just the prostate. In that case, some doctors want to go a year to a year and a half with ADT. It’s very possible that Prostate cancer has entered your bloodstream because it had spread beyond the prostate. You could still go into remission for many years, Sometimes it becomes dormant and doesn’t come back for decades, Continuing ADT would suppress the cancer from coming back for a longer period of time. It may not be necessary ask the doctor that wants you to go on ADT longer why?

I’ve been on ADT for eight years now. Really not had much of a problem with it. Had a lot of hot flashes in the beginning, but those are gone. I do run on a track a mile twice a day and go to the gym three days a week. I’m 78 and I’ve had prostate cancer for 16 years. I’ve lived this long because I’ve stayed on the drugs, While they can be a pain, they are beneficial.

You could get a decipher test, which would tell you the likelihood of having a reoccurrence. If it comes up with a low number, then you probably don’t need to go on longer than six months of ADT.

Hey @jeffmarc
"With a 3+4 they usually don’t recommend any ADT."
Would they usually recommend ADT for 4+3?

@web265
In my case they didn’t, after surgery. I was a 3+4 before surgery and a 4+3 after. I went 3 1/2 years after surgery before my PSA started rising. Pretty sure ADT would not have been given to me that long if they did recommend it.

Below guidelines, highlight the fact that in your case, you would need two of these three things before ADT would be recommended. PSA 10-20, GG2 or 3, T2b-c. So, where do you fit Based on your past history?

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)

@jeffmarc
My PSA was 18 before the surgery, gleason was 3+4 so that would be GG2, the only thing I am not sure of is the T2b-c, the cancer was contained in one area of the prostate but after removal and PET scan, it showed up in the area of the removal, so some had escaped the gland. All clear after radiation and my PSA has maintained a .006 score.

@web265
In my case they didn’t, after surgery. I was a 3+4 before surgery and a 4+3 after. I went 3 1/2 years after surgery before my PSA started rising. Pretty sure ADT would not have been given to me that long if they did recommend it.

Below guidelines, highlight the fact that in your case, you would need two of these three things before ADT would be recommended. PSA 10-20, GG2 or 3, T2b-c. So, where do you fit Based on your past history?

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)