Hormone therapy or not ? A helpful tool to decide?

In your decision-making, remember that the miserable QOL side-effects can be minimized with a robust resistance-training program.

In this 2023 paper, they fully describe a study and the rigorous resistance-training program that they used and the outcome: https://journals.lww.com/acsm-msse/fulltext/2023/04000/resistance_exercise_training_increases_muscle_mass.2.aspx

We often hear about the physical benefits of exercise to minimize the side-effects of hormone therapy (https://m.youtube.com/watch?v=YE61HSAsFb0). But, there are also mental health benefits as well: https://m.youtube.com/watch?v=8n0cIhamFvo

So, don’t rule out ADT if you’re able to engage in robust resistance-training.

(In my case, at 65y with a 4+3=7 and a PSA of 7.476, I did multi-joint exercises that utilize the largest muscle groups: squat, deadlift, bench press, row, overhead press, and lat pulldown exercises for a total of 1-1/2 hours each day. On alternating days, I would also add some cardio - either jog 3-4 miles or swim 35-45 minutes.

On the 7th day I rested…..

Though I still experienced mild warm flashes, loss of muscle mass and strength, and libido (but no ED), I didn’t experience many of the debilitating side-effects many often mention. All things considered, I got through the hormone therapy quite well.

Good luck with your decision!

@jeepio
My diagnosis was similiar to yours. Gleason 3+4=7. My PSA at time of treatments was 3.75. But had steadily increased over the years.

You asked about hormone treatments and type of radiation treatments. Regarding hormone treatments. You do know that it curtails testosterone which prostate cancer feeds off of it. It can help retard growth while you are going throught treatments.

My original diagnoses was intermediate risk and radiation with hormone. I was offered a Decipher test, PSMA, and bone scan. Back then had little knowledge of what they were.

Decipher test came back as low risk not intermediate and the recommendation for having hormone treatments was removed and just radiation. The PSMA showed negative as well as bone scan.

Would really suggest you look into Decipher test, PSMA, etc. before making decisions including second opinions.

Regarding proton and photo radiation. They have almost identical success rates. The difference is that proton radiation goes into body at lower does, releases if full dose at specific location and does not continue through body. Photon enters body and exit body and the diffference is that proton may reduce radiation damage to other organs and tissues.

Those who have had hormone treatments can advise on side affects of them. But for radiation I had very miniumal side affects with 30 rounds of proton radiation at UFHPTI.

I think either Artera or Decipher are both excellent to determine aggressiveness and tendency to spread.
Remember - all G3+4’s are not created equal and some can be more aggressive than even higher grades.
As @brianjarvis stated, don’t let the SE’s of ADT scare you - the stuff could save your life and there are ways to cope with it. My PSA started to rise 5 yrs after surgery. One RO said I needed no ADT based on a recent retrospective study.
I disagreed and my second RO at Sloan said that he would strongly recommend it.
In fact, he laughed that most men fight with him about this and he was glad he didn’t have to twist my arm to agree to it. Ask for Orgovyx if you do opt for it - great drug, less pronounced SE’s (in most, not all). Good luck on your decision.
Phil

Couple of recent patient webinars on PCF.org on hormone therapy, and one last Tuesday which may be posted or posted soon.
Personally, it would be hard for me to reject a short course 4 - 6 mos of ADT, which I understand weakens the PC and makes it more susceptible to the radiation, which is the "killing mechanism".
I did 4 mos Orgovyx with salvage radiation treatment immediately following RP.
However, there seems to be more instances of radiation treatment without ADT in the 3 + 4 = 7 sphere.
Best wishes on your decision making and treatment.

For what its worth, my Gleason score was 3+4 (< 5%) on one biopsy sample. Of the remaining 16 samples, two showed 3+3. My PSA was 8.4. As 3+4 is considered intermediate favorable, I was told by the radiologist dr. that no hormone therapy would be required. I had photon radiation, 7000 cGy, 28 sessions of 250 cGy, without gel spacer. I am three weeks since last session, getting less tired but overall feeling good. If my PSA doesn't respond as expected in three months, then I still have the option for hormone therapy later.