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prostate cancer ADT injection

Posted by imnru @imnru, 18 hours ago

I’m 62 and will start Proton Therapy next week. My psa is 8, with a 3+4 Gleason 7. my doctor is suggestion ADT for 6months. I’m concern with the muscle loss and other adverse affects. Is the benefits worth the toll it will take on my body?

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wwsmith | @wwsmith | 1 hour ago
In reply to @brianjarvis "@northoftheborder Good choice. Regarding the testosterone surge (especially with a tumor near your spine), this testosterone..." + (show)
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@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.).

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@brianjarvis When I got my first of two 6 month shots of Lupron neither my urologist or RO mentioned anything about a testosterone flare. So when I came home to my wife after the shot and said something like, "Well, I just got my death by lethal injection shot. Wonder how long before I start feeling all the bad side effects."

And lo and behold, over the next few days my lifts went up and my desire for sex went up too! I was thinking that ADT isn't going to be bad at all. Maybe they gave me the wrong thing? Of course, as I dug into what was happening I did read about the testosterone flare and the testosterone boost did go away and my strength and libido started to drop as well.

But thinking back on the situation, would I have rather had some Casodex to eliminate the flare before the shot? Not really, the flare was fun! And I had a whole year of ADT to go so the little two week delay on the testosterone drop didn't really matter.

What ended up mattering was the long testosterone recovery after Lupron was supposed to expire. I thought it might take a month or two, but it was about 5 months before testosterone recovered to a normal level. I would highly recommend that a man use orgovyx instead for ADT so as to enjoy a much quicker testosterone recovery.

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jeff Marchi | @jeffmarc | 51 minutes ago
In reply to @readandlearn "@jeffmarc The two drugs I was taking were Lupron (shot every 12 weeks) & Abiraterone (4..." + (show)
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@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.

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@readandlearn
Zytiga Is a drug that acts like ADT since it further suppresses testosterone like ADT, But it is an ARPI as I’m sure you’ve found out. I was on it for 2 1/2 years and it was never easy. I was only undetectable for one month in 2 1/2 years. My PSA kept going up and down.. When I stopped it, I had to have a metastasis in my spine zapped because it just didn’t work well enough. It did give me high blood pressure, lots of hot flashes and four afib events. Not an easy drug to live with for many people.

The problem with stopping the drugs is that the metastasis are not always killed when you’re on them. They shrink in size and stop growing completely, but they may be there to come back again. It could be proton radiation could enable you to have that one on your lymph gland zapped, If it comes back, need to speak to a radiation oncologist that does proton.

If they have you get back on ADT Try to get them to prescribe Nubeqa. Unlike Zytiga, it has very few side effects, Most people don’t notice any. Zytiga did not stop my PSA from going up and down, I’ve been undetectable for 26 months on Nubeqa.

Hopefully your PSA stays undetectable for a long time.

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brianjarvis | @brianjarvis | 24 minutes ago
In reply to @wwsmith "@brianjarvis When I got my first of two 6 month shots of Lupron neither my urologist..." + (show)
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@brianjarvis When I got my first of two 6 month shots of Lupron neither my urologist or RO mentioned anything about a testosterone flare. So when I came home to my wife after the shot and said something like, "Well, I just got my death by lethal injection shot. Wonder how long before I start feeling all the bad side effects."

And lo and behold, over the next few days my lifts went up and my desire for sex went up too! I was thinking that ADT isn't going to be bad at all. Maybe they gave me the wrong thing? Of course, as I dug into what was happening I did read about the testosterone flare and the testosterone boost did go away and my strength and libido started to drop as well.

But thinking back on the situation, would I have rather had some Casodex to eliminate the flare before the shot? Not really, the flare was fun! And I had a whole year of ADT to go so the little two week delay on the testosterone drop didn't really matter.

What ended up mattering was the long testosterone recovery after Lupron was supposed to expire. I thought it might take a month or two, but it was about 5 months before testosterone recovered to a normal level. I would highly recommend that a man use orgovyx instead for ADT so as to enjoy a much quicker testosterone recovery.

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@wwsmith I suppose that a testosterone boost can be fun; but, if a tumor that flares happens to be near the spine (or some other critical anatomical structure), that boost/flare might not be such a good thing (which is why they use Casodex).

Though there are no hard and fast rules on this, guys that I’ve spoken to say that once the time on Eligard is set to expire, to expect about 50% more time for the ADT to leave the system, testosterone levels to bounce back, and side-effects to subside. (My 6-month Eligard experience lasted 3-1/2 months past the end of that 6-month period.)

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wwsmith | @wwsmith | 9 minutes ago
In reply to @jeffmarc "@wwsmith Really hit the high points. NCCN who sets the guidelines doesn’t call for 3+4 to..." + (show)
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@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)

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@jeffmarc When I first began studying prostate cancer, I would read about following the SOC (standard of care). I had always thought the SOC was some kind of unwritten typical treatment protocol for certain conditions. But now, if I am thinking correctly on this, following the SOC actually means following the most current NCCN Guidelines, right? And if that is correct, I am going to start mentioning that more in posts to new patients and even provide the link for the NCCN Guidelines https://www.nccn.org/guidelines/guidelines-detail

Like you have been doing, I think it is important for all patients to know what the Guidelines say for their condition so that they can compare what their doctors are recommending against the Guidelines. Deviations from the Guidelines are certainly ok if the doctors can make a good case for those deviations. But patients should always be involved in the process and be prepared to question and give their own input towards what is the best treatment for their particular case.

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