Hormone therapy before radiation treatment question....

If ADT lasts less than 2 months just keep up with the exercise (fight through any fatigue). It usually takes Orgovyx about 2-4 weeks to lower the testosterone. Even short ADT is usually about 4 months and that is after or concurrent with radiation. Pre-radiation ADT is usually to stop potential spread while deciding on treatment or shrink a very large prostate. Even on Orgovyx it also takes 4-8 weeks for testosterone to return to normal levels.

If he wants you to take a daily ADT, then he probably is going to give you Orgovyx, The only ADT you get daily. Orgovyx For ADT Allows the testosterone to come back much quicker, which will minimize the side effects.

While you will have some effects from the ADT. They should be very short term. Muscle loss bone deterioration are all things that happen over time not enough matter of a couple of months. You could do some weight exercises to keep the muscles you have in shape.

Whether or not you gain weight is up to you most of the time. Weigh yourself on the scale daily and eat based on what you weigh. I’ve never gained weight and I’ve been an ADT for eight years.

You may get hot flashes. If you do, there are some resolutions, Come back and ask if you have a problem with them.

3 1/2 years after my surgery, my PSA started rising, so I had salvage radiation. They gave me a six month Lupron shot two months before the radiation. To tell you the truth, I didn’t really have any side effects at all from it. He’ll be much better off with Orgovyx.

Recent studies I’ve shown it’s more effective to have ADT at the time of radiation Or shortly after it rather than Before radiation. Here’s some information about that you could talk to your doctor about. This is pretty new information and doctors are not really doing it yet.
https://www.medscape.com/viewarticle/940049
Some information on radiation treatment, if you’re cancer comes back.
People who have radiation as their primary treatment have been told by doctors that surgery isn’t really an option if there’s a reoccurrence. Other options are not really mentioned..

This study shows that both salvage focal therapy (HIFU and cryotherapy) and salvage surgery were equally effective at extending the life of a patient that started off with radiation.

Those that had focal therapy had fewer perioperative complications.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2844900
.

You will probably continue ADT for 6-8 weeks after radiation as well; it’s usually a 6 month total, but 4 is also done.
Keep exercising -especially when you don’t feel like it! Pushing thru the fatigue is KEY for success.
Also, get your body used to low fiber meals - gas in the bowels is a big no no! The Linac machine is great when it comes to thus because it automatically turns off if a gas bubble moves your prostate out of target range; but your RO won’t be happy if the 15 minute procedure becomes an hour or more because of gas issues. Do some diet homework! Best,
Phil

Welcome to this forum. I m an agent orange veteran with GLEASON 9 , stage 4. Slight metastases to pelvic lymph nodes. Etc….. today 3 years down the road I m in remission. Arbiterone/ prednisone I had for ADT, plus 28 rad. Treatments. Last for 28 months including butt shots of Lupron/ Trelstar. Listen to Jeff Marchi: he s the expert. I m a novice compared to him. Don’t forget to eat those mushrooms daily in capsule or real form. I just started taking collagen to prevent wrinkly skin from the ADT. plus normal weight lifting/walking daily exercises. Two other dudes on here are: North of the border, Heavy Phil are smarter than me also. Listen to them. Have a nice cold ass day like I m having in Michigan LOL.

UCSF has some dietary guidelines for patients with prostate cancer. https://www.ucsfhealth.org/health-articles/nutrition-and-prostate-cancer
These don't necessarily apply during radiation treatment as the goal there is to minimize bladder and bowel activity that causes prostate movement during the brief time the radiation is administered.

I've been most interested in what I can do to counter the side effects of ADT.

There is a guy in Australia, Dr. Rob Newton, whose prime interest is how to use exercise as a first line treatment for prostate cancer. He is recognized as one of the leading exercise oncology researchers in the world. He claims the exercise programs his clinic develops for each individual patient that they treat has shown him that exercise can counteract "all" the side effects of ADT.

However, he seems reluctant to publish a general recommendation for patients who regarded themselves as in generally good physical condition prior to their PCa diagnosis. He appears most interested in studying advanced cases where unless he can intervene successfully, the patient will die. He watched his own father die of advanced prostate cancer after his father faithfully followed the then widely recommended prescription for prostate cancer which was to avoid physical activity and rest. This caused him to change his career path from being a top level physio coach for pro athletes, to prostate cancer research.

There is a PCRI video of a Newton detailed presentation of an overview of his research.

Exercise is gaining more attention as a first line treatment for PCa. The phase 3 CHALLENGE trial was significant enough that it was presented at a plenary session at the largest oncology conference in the world, ASCO 2025. It made it into the New England Journal of Medicine as well. It is the first randomized trial to prove that a structured, long-term exercise program significantly improves survival in patients with stage II-III colon cancer. Exercise reduced the risk of cancer recurrence or death by 28%.

ADT vrs no ADT does not improve patient outlook by that much.

Newton, with Kendricks of UCSF, et.al. has a multi center study going that looks identical to this, except the patients studied all have advanced prostate cancer. This is the INTERVAL-GAP4 Study, entitled "Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer". Trial Registration number: NCT02730338. My fairly local NCI designated cancer center was a location for this study, but they would not provide me with any info as to what exercises were prescribed or recommended, and at their location, the study is concluded.

Exercise seems to be a tremendous help in getting through ADT. I started relugolix about 4 weeks before SBRT and am ending it after 6 months. During the 6 months I kept up my exercise routine - walking several miles 4-5 times a week, some light weight work, stretching - and at 80 I felt fine once the SEs from the radiation cleared. I've had mild hot flashes which have been annoying but not an interruption to my daily routine.

I have one question about the study mentioned above about the advantage of beginning ADT when radiation starts rather than weeks before. The study is from 2020 which precedes some of the advances in radiation treatment - MRI Linac and adaptive CT monitoring. My RO and my urologist independently told me that weakening the pc prior to treatment would make the radiation more effective. That sounds like an advantage that would be lost if ADT started at the time treatment began.

@ecurb

Welcome Home brother.....Thank you for the input!

I had fun texting you. lol. Suffer mostly from fatigue now in the afternoon. It’s from low T/ radiation treatments- not sure which one.

@ecurb
While you suffer from fatigue, be careful about how much sleeping you do in the afternoon. I occasionally get tired in the afternoon, I take a 25 minute nap setting my phone for 25 minutes. That keeps me awake till midnight.

The problem is, if you sleep more than about an hour, you go into REM sleep. Once that happens it makes it more difficult to sleep at night. People find they’re not getting a full nights sleep when they do that, and as a result, they are tired in the afternoon. The short naps resolve that issue and allows you to get a full night’s sleep.

@climateguy Hi there - I'm just reflecting on your statement "ADT versus no ADT does not improve patient outlook by that much". Apparently it depends heavily on the risk group and the stage of the prostate cancer being treated.
While androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer treatment, research shows its benefit varies significantly:
Low-Risk Disease: The statement is True. ADT provides little to no survival benefit for low-risk, localized prostate cancer and is generally not recommended as a first-line treatment.
High-Risk/Locally Advanced Disease: The statement is False. Adding ADT to radiation therapy (RT) for high-risk, localized, or locally advanced disease (T3/4) shows significant improvement in both disease-specific and overall survival.
Metastatic Disease: The statement is generally False, but nuanced. ADT is standard care, but modern treatment involves adding newer agents (ARPIs) to ADT to significantly improve survival over ADT alone