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

@pesquallie
"A study at Duke indicated that high testosterone is better if you have aggressive prostate cancer."

I got a little concerned when I read this as I am on a T-Blocker to reduce a recurrence of my cancer. Here is some context on the Duke study:

Yes, that is correct based on a September 2024 study from the Duke Cancer Institute, but with important context: it applies to specific advanced stages, not early-stage disease.

Key details:
The Mechanism: While low testosterone is used to slow early prostate cancer, Duke researchers found that in later stages, high-dose testosterone can force cancer cells to differentiate (mature) and stop dividing, reversing the growth stimulated by low-testosterone environments.
Bi-Polar Androgen Therapy (BAT): This approach, often called bipolar androgen therapy, involves rapidly cycling between very low and very high testosterone levels to treat castration-resistant prostate cancer (mCRPC).

Context: This is a therapeutic strategy for advanced, therapy-resistant cancer, not a general suggestion that high testosterone is "better" for all prostate cancer patients

@capatov You are blessed with a truly wonderful outcome !!!

At 73, I was diagnosed Gleason 7. PSMA PET scan showed three lesions in prostate and likely activity in both iliac lymph nodes. I was prescribed 24 months of ADT (Orgovyx), later reduced to 18, and 44 IMRT treatments, 26 to pelvis generally and 18 to prostate only. Mine has been an exceptional case, experiencing all the side effects on the Orgovyx.com website and developing radiation proctitis even though a SpaceOar gel was inserted prior to radiation as protection. No sex since starting ADT, and I have about six weeks left. Cancer has seemed to have been completely subdued, but life is different when your testosterone is maintained at < 10. You're considerably younger, but your cancer is judged to be aggressive. You might try radiation alone, followed by ADT only as backup. I have a 53 yo friend, though, who had a radical prostectomy. Nerve sparing was successful, and he is doing great with no radiation and no ADT. He's also an exception. Saying a prayer and wishing you well as you choose.

@jime51

Similar treatment and results for me but side effects have been horrible. At age 83, and one year since stopping 4 months of Lupron the side effects are about 50% of their peak but still very painful with severe headaches plus joint and bone pain 24/7. Testosterone at 115 and PSA < 0.03. I wonder if the pain will ever stop.

@pesquallie Sorry for the ongoing issues! My side effects from Orgovyx became a little more livable after being on the drug for a year, but should subside about three months after I complete the series late June. I've not had headaches but I have lots of arthritis regardless treatment and can only take Tylenol due to being on the blood thinner Eliquis. I hope your symptoms resolve soon! The fact that your Testosterone is coming up gives me hope. On Orgovyx, mine is < 10.

@jime51

It is likely that what you describe as arthritis is actually a side effect of the ADT which attacks muscle and bone.

@johnsonjn Both surgery and radiation have lower risk of ED with improved treatment methods. This is nerve sparing for surgery and better targeting that misses the penile bulb for radiation. For radiation you want to have the latest equipment with either MRI or CT targeting of the prostate (ie IGRT). One of these will be built into the latest radiation machines. Even though there is mixed data on effectiveness I followed the surgery penile rehab practice of using 5mg generic Cialis daily during and after treatment. It is cheap and also improves urine flow (not as much as Flomax but with better side effects). Strategy is to keep the blood flow and hope to prevent fibrosis scar tissue a primary cause of radiation ED. As far as ED, Brachytherapy probably has the best profile for least loss (is highest for urethra side effects).

Before getting IMRT you want to get a Prostox test. This is newly (2026) commercialized germline genetics test developed at UCLA that predicts if you are in the 12-13% of the population that have a high risk (avg. 75%) risk) of late radiation toxicity. Most common are ED, radiation proctitis or cystitis. These can occur 1-3 years after treatment. If you are not high risk on Prostox there is still a 7% chance of having one of these symptoms. There is a discussion of Prostox with video on this board. There is a separate test for SBRT with about 20% overlap of a person scoring high on both.

Check with your insurance to make sure the treatment you want is covered. Almost no work insurance (including mine) will cover Proton radiation. May not cover SBRT (5 fractions at 7-8 Gys) as a primary treatment. IMRT at 20 fractions of 3.0 Gys is preferred but up to 39 fractions at lower Gys may be approved. Regardless of the protocol get SpaceOar or other gel to minimize rectal side effects.

On ADT testes shrink 25-50% even in 6-months. Recovery tends to be slower but does occur when off the meds. They will also give you ED which I expected. I took Calcium Citrate w/D3 to minimize ADT induced bone loss.