IMRT/VMAT Radiation with 6 months of ADT - anyone??

@johnsonjn Is there a reason you are selecting surgery over radiation? I had 2 Gleason 4+3's and did 20 proton treatments. Proctectomy's are no more successful than radiation quote my Yale educated urologist.
I went on the carnivore diet when I got diagnosed, cancer loves sugar almost as much as testorone.

Hi,
As far as your ADT drugs you might want to go with some of the newer ones like Orgovyx which have less side effects than an older drug like Lupron.

Dave 3+4

@narus - thanks - i did have the level checked before the meds. did you have it checked b4 and after for comparison. Curious to know you results/drop

@narus - i have not had either RT or RP - but getting set up for IMRT and having 2nd thoughts. - i am encouraged by your reply and Yale urologist - FYI i really need to back off the sugar !!

@clevelandguy - your profile name made me chuckle. I am being treated at Cleveland Clinic in Vero Beach FL I am meeting with my urologist and requesting him to prescribe Orgovyx before i start the ADT

Hi,
I think the newer ADT drugs are a better choice. The reason I chose Clevelandguy is because I live in a small township south of Cleveland. I had all of my cancer” stuff” done at University Hospital Siedman cancer center. We are so luck to have the Cleveland Clinic and UH close to us, Very top notch in my book👍
Dave 3+4

@johnsonjn I came down with prostate cancer in 2021 in the middle of Covid. What was disappointing is the 2 years prior to my diagnosis my PSA was rising like a rocket but my nurse practitioner did not think it was relevant till it went over 6.
I took a 3 month Lupron shot a month before I started my 20 session radiation treatment. Half way thru the treatment I had 0 energy and a lot of trouble walking. I was like a 90 year old trying to drag myself out of bed in the morning. The doctors at the hospital were clueless and had me do a Brain MRI and I started six months physical therapy. Reading online on my own I went out and had my own testosterone test and eight months after Lupron it came back as 100. I started testosterone replacement therapy and the day after I took the first injection all the physical issues I was having went away. No I did not test my testorone before Lupron. After Lupron my sex drive probably dropped 95% and a pretty girl did not even rate a 2nd look. Right now I take .5ml(12mg) of IM injection of testosterone cypionate every 5 days. My last testosterone test came back at around 680 three months ago.I lost 75 lbs and started lifting weights and am healthier than I have ever been. Yes my urologist was skeptical about TRT at first but my PSA just keeps dropping. Even after TRT my sex drive is nothing compared to pre Lupron but at least I like girls again.
If you are trying to decide what to do check out Youtube plenty of video's from renowned urologists explain it all.

Beware Yale doctors tend to be woke progressives.

I did 28xIMRT + Camcevi (Leuprolide) and I'm as happy with my decision as you can be with two awful choices. I had my last shot in December and my Zitiga is running out in 3 weeks!

The most common comments I read here about RP are about what I thought when I researched and personally I'm happy not to have chosen it. The IMRT/ADT approach is definitely not a walk in the park and is also very likely to have sexual side effects. In my experience these are barely mentioned in the original Doctor meetings which probably shows just how likely they are.

As an aside, my (youngish) Radiologist (who I met first) recommended IMRT/ADT and the (older, very experienced) Urologist recommended RP. He also dissed her experience a little. For my second, pick-one meeting with him I had firmly decided to go with her recommendation and I went to him prepared with a lot of information and statistics. He walked in and after the preamble, said: "I think, in your case, we should go with radiation..." I laughed and showed him my now unnecessary preparation notes.

RP is certainly very immediate and afterwards you are effectively "cured" but the effects are nasty and I keep hearing recurrence stories on here (comparison statistics must be easily available but I haven't looked). I know if I have a recurrence my options will be much more limited but I'm ignoring that for now.

I laugh at myself and talk about my 2 years [chemically] identifying as a woman. It really has given me a lot of insights that I didn't have before. Sexuality is very strange, I still love women (and I have a new, super-understanding girlfriend) but you simply don't get that familiar chemical reaction to sexy situations. Seeing a hot girl isn't hugely different to me as seeing a very interesting car - but I do like cars 🙂

We're waiting patiently for my T to come back and I'll do whatever it takes for a practical approach to penetration. But our sex life has been excellent, rewarding, frequent, and lengthy even if it is 95% concentrated on her for now. From right here right now, I feel like penetration will be a bit of a side show when I do manage it. Her pleasure is very rewarding to me (and it is the number one thing that will lead to a 3/4 Viagra erection) but it's a little detached as if she was really enjoying something I had cooked for her.

Knowing that there's a 99% chance I will never ejaculate again makes me sad (that was never mentioned in my doc meetings nor did I find it during research) but I will adapt and there will be all kinds of benefits for ease of clean-up 🙂 I am also hoping to be multi-orgasmic as is sometimes reported here.

No-one can really help you with this decision. It will be full of your and our conformation bias. Good luck!

@narus

A study at Duke indicated that high testosterone is better if you have aggressive prostate cancer. Their initial study indicated that ADT only helps about 5% of men while 100% suffer from side effects. They have an ongoing program using AI to determine the characteristics of the 5% so they can limit ADT to only those who would benefit.

@johnsonjn Casodex is prescribed with Lupron for about a month to counter the testosterone flare (increase) that Lupron causes in the first month. Orgovyx does not have a flare so this is not required. Also, at 3+4 you do not want to suppress the minor amount of testosterone coming from the adrenal glands since that can increase the chance of side effects. Orgovyx will take testosterone levels below 20 within a few weeks.