Hormone Therapy (ADT) when ArteraAI Test says it's not necessary

First, you should totally exclude Lupron because once you are jabbed you are stuck in more ways than one even with severe side effects. Also, limit to 4 months. Do they even know if it should be adjuvant (post) neoadjuvant (pre) or current? Recent studies have shown that adjuvant provides better results. If that is the case, you can agree and decide after treatment if you should take the Orgovyx. With Orgovyx you can also stop at any time. It will take 4-8 weeks after stopping for testosterone to return.

I had Orgovyx without extraneous side effects (hot flashes, night sweats, etc.) but more than 50% taking Orgovyx (higher on Lupron) report these symptoms so you might not be so lucky. Anyone on ADT will need to do resistance training and take calcium supplements to minimize bone and muscle loss. I had no muscle loss, and bone loss was minimal (DeXA scans pre and post). What cannot be controlled is shrinking of testes and failure of testosterone to return to base levels. At your age you can expect a permanent decrease in testosterone levels. Check total testosterone pretreatment and see if you have a 25% buffer to lose post treatment. It could be either less or more. It is unlikely that you will not get most of the baseline testosterone level back (65%-80%) but becomes fairly common in late 70s or older for ADT to cause 50%-80% loss from baseline.

The side effects of ADT for 4 to 6 months is no big deal for most people. My brother had it for six months at 77, Gave him hot flashes, but that was the only problem. The hot flashes did last for about six months after the drug had worn off, but they got milder as time went on. The radiation caused cystitis, but it wasn’t too bad and went away after a few months of the end of radiation. Flomax every other day was all he needed.

I’ve been on ADT for eight years, You would never know it if you met me.

If you want to counteract the minor effect that will have on your muscles, go to the gym three times a week and do a lot of situps.

@jim18 Thanks for your insights. Yes, just based on the descriptions of Lupron vs. Orgovyx when I met with the UofMD doctors, I ruled out Lupron since it lingers and the side effects last longer. They described the ADT as starting before proton therapy and lasting 4-6 months, so throughout and well after 5-1/2 weeks of radiation. Not sure if the falls into neoadjuvant (these terms are all new to me).

I'm not sure if I'd know if I had a 25% buffer of testosterone, but I'll certainly ask the medical team about testing.

And still, the question of whether to trust the ArteraAI testing outcome still lingers. Part of me would like to believe that ADT isn't necessary and just avoid it. After all, it is an esteemed institution like Johns Hopkins telling me this. But I fear recurrence regardless.

@jeffmarc Thank you for this information. I do exercise... volleyball for a couple of hours twice a week, walks with the wife and dog most days. I suppose for a limited ADT treatment period that may be enough, but I'm glad to do more!

@tjnoffy
One of the early problems people have with ADT is they get a noticeable belly because the stomach muscles weaken. I was always very thin so it didn’t bother me, It can’t hurt to do situps.

@tjnoffy neo is before. As far as prostate cancer goes even if ADT does not help it will not hurt. However, your overall health might decrease if you lose bone, muscle, and have low testosterone for the rest of your life. That is the case against ADT. As mentioned, you can take actions to minimize the negative effects while on ADT.

The arterAI test is saying that for your case short term ADT will not improve overall survival. arteraAI is a new test. What did they score you on the 10-year distance metastasis and what percent were you in the intermediate risk group (both on arteraAI report)? I take it you were ST-ADT Biomarker Negative. I do not believe the biomarker(s) used are published so it is hard to comment on accuracy with no history. Other than biopsy slides they have Gleason, PSA, and stage data so not a genetic test.

As far as risk of recurrence did you have a Decipher test from biopsy tissue (it provides recurrence risk)? What percentage was type 4 from biopsy (higher is usually higher risk of both recurrence and metastasis)? Are you going to get a Prostox std test (genetic) for long term radiation GI side effects (calibrated with photon radiation but will be correlated with Photons) risk)?

@jim18 While I agree with you that there might be no difference in ‘long term outcomes’ - which is survivability vs lethal outcome - I do think there is a difference if you factor in ‘metastasis free’ survival.
Two men may both live 15 years after treatment, but the addition of ADT ‘could’ make those 15 years event free, while not adding ADT might lead to recurrence or worse, metastasis and all the treatment that goes with it.
Six months of Orgovyx (not Lupron!) is totally do-able and only mildly annoying if you follow a physical exercise regimen of cardio and weight training.
I feel, personally, that it is a small price to pay for that added measure of success. Even Artera AI only has the knowledge that we’ve gathered SO FAR; who knows what gene on that humongous DNA chain will be discovered down the road, showing a peculiar mutation which responds favorably to ADT?
Just my thoughts sculpted by the saying ‘We don’t know what we don’t know’. Best,
Phil

When evaluating the length of time one needs to be on Orgovyx how useful is considering a Prolaris Biopsy Test results vs Decipher?

@jim18 Some of what you're asking here I don't know. I'm drinking from a fire hose, as I'm sure everyone here has at the outset. Here is what I do know from the ArteraAI test:
10-YEAR RISK OF DISTANT METASTASIS: LOW group (not INTERMEDIATE), 2.4% risk
10-YEAR RISK OF PROSTATE CANCER SPECIFIC MORTALITY: 1.1%
COMPARISON OF THIS PATIENT TO THOSE IN SAME NCCN RISK GROUP: 28th percentile
ST-ADT BIOMARKER: Negative
Looking at the drawn map of the biopsy, two of 13 biopsy sites were Gleason 7 (4+3), one was Gleason 7 (3+4)
I don't see any indication of a Decipher test, and a Prostox Std test has not been mentioned.

Regarding the choice of proton therapy:

I was surprised when I first asked my Radiation Oncologist (RO) about proton therapy for my "at least high risk" prostate cancer. This guy was a senior oncologist at an NCI designated cancer center in a big city. You can't listen to a sportscast in that city without being inundated with ads promoting the fantastic proton treatment for prostate cancer that this center offers. The RO explained that the prostate cancer department in that center does not believe protons are in any way superior to photons. They think the ads are misleading.

Recently I heard an interview of Dr. Brian Davis, radiation oncologist at Mayo Clinic Rochester, recorded at the 2025 SouthWest Prostate Cancer Symposium. The Mayo Clinic there is putting in a second proton facility, so they must like what it can do. He started out his talk saying they had a large donation that helped them build the facility, to say they don't have to worry about treating everything in sight to justify a huge investment.

Are protons better than photons, for prostate cancer in particular? It's a "wash", he says. Protons are clearly superior for some types of cancer.
https://grandroundsinurology.com/proton-therapy-for-prostate-cancer/