prostate cancer ADT injection

A 3+4 case usually does not get ADT. Do you have any other extenuating circumstances like a high Deciper score, intraductal, PNI, or anything like that to cause the need for ADT?

@wwsmith Really hit the high points.

NCCN who sets the guidelines doesn’t call for 3+4 to have ADT unless there are other issues

Here are the guidelines, ask your doctor why he thinks ADT would be right for you since NCCN does not call for it.

NCCN Guidelines

Here are current NCCN Guidelines in 2025. They now suggest 0 (zero) months of ADT for low intermediate (GG2); 4-6 months for high intermediate (GG3), and 18-36 months for high risk (GG4 and 5). Actually, the footnote suggests ADT + abiraterone for T3b with lymph node involvement.
The meta-analysis suggests:
* 0 months for 1 intermediate factor (PSA 10-20, GG2 or 3, T2b-c)
* 6 months for 2 or more intermediate factors (PSA 10-20, GG2 or 3, T2b-c)
* 12 months for NCCN high risk (PSA >20, GG4 or 5, T3 or 4)
* undefined for NCCN very high risk (2 or more PSA >40, GG4 or 5, T3 or 4)

You will hear horror stories about ADT here, but there are other stories, including mine. I was on Lupron & ADT (they are distinct & different) for 2.5 years after my PSA rose after surgery. My side effects were very mild: A mild hot flash about once a month (which I found amusing), & not having to shave every day.

When my oncologist offered to take me off of hormone therapy, I initially declined, because I saw no benefit. Then I thought maybe the cancer was in remission, so I took the doctor's offer. At the first suggestion from him that I should go back on hormone therapy, I will resume it.

Remember, success cases often don't come here to report. A lot of very unhappy people do come here, especially recently.

@readandlearn
Lupron is ADT, There is no distinction at all between Lupron and ADT since it is an ADT drug.

You would not be on two ADT drugs so I suspect you were also on an ARPI drug (Zytiga or a lutamide) not a second ADT drug.

Just wonder what is that other drug you were taking.

When I was on Lupron, I got terrible hot flashes for the first year. 10 or 12 a day at least and each one would accompany a feeling of fatigue. My doctor prescribed a depo-provera Shot which almost completely stopped the hot flashes. Then I went on Zytiga and they came back. That got me using the Embrlabs.com Wave device Which helped control my hot flashes a lot.

I did take Lupron for a total of six years and got used to its side effects.. It does destroy your muscles And gives most people a beer belly. I go to the gym three days a week to offset that. It also weakens your bones, I have taken bone strengtheners for the last eight years.

I’ve been on orgovyx For almost 3 years now. It’s another ADT drug, Works Quite similar to Lupron, Doesn’t give me the hot flashes like Lupron did however.

Just one point to add: instead of ADT injections (Lupron or Firmagon) you can get ADT in pill form these days (Orgovyx).

I found a big quality-of-life improvement when Orgovyx became available in Canada, because I no longer had to deal with swelling and 2–3 days of flu-like symptoms after every monthly Firmagon injection.

@northoftheborder Firmagon injections will often result in swelling and other undesirable injection symptoms.

There are many types of ADT besides Lupron, Firmagon, and Orgovyx. There are other ADT injectables like Eligard, Prostap, Camcevi, Lucrin, Zoladex, Trelstar, Pamorelin, and Decapeptyl. (I had Eligard.)

No matter which ADT is chosen, the literature indicate that resistance-training exercises minimize ADT side-effects.

@jeffmarc
The two drugs I was taking were Lupron (shot every 12 weeks) & Abiraterone (4 pills daily).

I stand corrected about ADT.

I was told by my oncologist that Lupron suppressed testosterone from the testes, & the Abiraterone was an ADT drug that suppressed testosterone from other androgen (adrenal) sources. Hence, the distinction. I now see from Google that I misunderstood part of that.

After I had been on ADT for 1.5 years, I decided to move to another state, from one 2-story house to another. I had help loading/unloading the four 8'x16' "Pods" with some furniture, but otherwise the beds, chairs, tables, & numerous boxes & computer equipment by myself. I have a slight frame & am not particularly muscular, having worked (like you) as a computer desk jockey for most of my life. I did not experience any fatigue over what I would normally have felt, but did lose some weight.

I did feel a slight increase in strength & balance when I dropped ADT the following year. If I had not known about the effects of ADT, I would have thought that the change was due to getting more exercise. I also gained 20 lbs (which I have since lost by diet).

If I go back onto ADT, I will probably ask about switching to Orgovyx. I had no post-injection symptoms, but like the idea of no brain fog. I don't know whether I had any brain fog due to Lupron, because forgetting stuff is not only part of getting older, but I had a head start. I often forget people's names that I don't regularly deal with, but then when I was on dates when I was 19, I forgot the name of my date sitting next to me in my car (this happened with two different dates). Fortunately, I was able to recall the names before I needed them. At least now I have an excuse, but don't need two.

About six months after surgery, when my PSA started to rise again, they did a PET scan & found a spot in a lymph gland 1cm from my lower aorta. The radiologist wanted to zap it, but my oncologist thought that was too close to the aorta, & offered ADT instead. I agreed.

If my PSA rises to 0.20 or above, my current oncologist wants to do another PET scan. If that happens, I will have to decide again about radiation or ADT. I have a bit more information now (from this forum), so it will be an interesting decision to make.

@brianjarvis We chose Firmagon at the time because my PSA was high (nearly 68) and the cancer was aggressive (it had already spread to my spine), so we couldn't afford the initial testosterone surge that many other types of ADT cause.

In 2021 Orgovyx wasn't available yet in Canada, unfortunately, but since it's a GnRH antagonist just like Firmagon, it was an easy switch in early 2024.

I had a injection of Lupron of 6 months before having 36 Proton radiation treatments. I endured it well and I worked my lawn care business every day during my summer treatment period. I was very tired by weeks end and I required all weekend to recuperate. Otherwise, life was normal for me. I was 75 years old at the time.

@northoftheborder Good choice.

Regarding the testosterone surge (especially with a tumor near your spine), this testosterone spike can be prevented by starting with Bicalutimide (Casodex) a short period of time before starting ADT, which blocks T from attaching to prostate cancer cells, reducing the risk of tumor (testosterone) flare when hormone therapy is started.

Tumor flare does not last long and will go away as the T level continues to drop.
https://www.oncolink.org/cancers/prostate/treatments/tumor-flare-in-prostate-cancer
Also, some these days start with Orgovyx (to prevent testosterone flare), then once testosterone is suppressed switch to one of the others (Lupron, Eligard, etc.).