Treatment options: radiation without ADT?

My various test values were nearly identical to yours at age 72. I did 6 months of ADT. With new research trial results recently published, I personally would consider passing on ADT at your age - if you do it, I would only do 4 months. At your age and Gleason 4+3, the potential negative impacts of ADT in my opinion outweigh the potential benefits. At minimum, get a second opinion from someone up to date on newly published research. ADT is not standard of care for 3+4 but has been for 4+3. The new research does not seem to support the older standard of care recommendations. ADT is nasty enough on metabolic health to avoid at your age in my opinion. If you were age 70, I might be more on the fence - but not at age 79. At minimum, research the Prostate Cancer Research Institute presentation on the new research on this matter for Gleason 4+3. In a nutshell, I believe advancements in scans and other prostate related testing render ADT for 4+3 less compelling. I wish you all the best.

Thank you for your reply.
My research mode is in “overload “
I’ve spent hours viewing the PCRI site. Currently scheduled for a third opinion with Stanford cancer center this week.
Just ran across data on new test by ArteraAI.
How are you currently feeling?

I had SBRT Proton (5 sessions) in May 2022 at MAYO with 6 months of ADT. I am feeling well now and my PSA tests have thus far been encouraging. No regrets with my decision other than the impacts ADT which is why I would really reconsider that decision now that newer research on Gleason 4+3 is shedding new light on this matter. The other matter to get your head around is that rectal bleeding is a relatively high probability shorter or longer term outcome with SBRT Proton treatment, even with the gel spacer that is important to have to protect the rectum. Be your own advocate on this matter when discussing it with the radiologist because they generally will not address it in any amount of detail during consults. I still believe my treatment decision was the right one despite some random light rectal bleeding. But if you can avoid the ADT, that is a far bigger issue in my mind. The impact on muscle mass and other metabolic matters is not insignificant. I am just now experiencing a slow return of testosterone and reduction in hot flashes. Also research the new ADT alternatives that instead of chemically castrating you simply act to block the testosterone produced by your body. Thus, the nasty side effects are far less. Not sure if it is covered by Medicare for your Gleason level but it is an example of how fast advancements are evolving. I feel your pain on the overload. Don't rush a decision. I have absolutely no regrets selecting radiation over surgery - but if the new perspectives on ADT for Gleason 4+3 had been published when I was at your point in the decision process, I absolutely would have avoided ADT. Hope this helps.

I was 3+4 with a high Decipher. The Decipher report recommended a multi-modal (i.e. with ADT) treatment approach. My urologist planned to give me ADT shots, but my RO was adamant that they were unnecessary and would do more harm than good. They put their heads together and the urologist ended up agreeing with the RO. Music to my ears. I am approaching the 1 year anniversary of concluding 39 VMAT sessions. I’ve had 3 PSA tests since then and each has been lower than the previous one (last one 0.79). Here’s hoping that they continue to decrease and that I made the right decision. Good luck.

Here are a few related discussions:
- Radiation with or without ADT
https://connect.mayoclinic.org/discussion/radiation-with-or-without-adt/
- Should you start ADT after radiation treatment or not?
https://connect.mayoclinic.org/discussion/should-you-start-adt-after-radiation-treatment-or-not/

See all https://connect.mayoclinic.org/group/prostate-cancer/?search=radiation%20without%20ADT&index=discussions

75, Healthy, very active, ride 80-100 miles/ week, lift 3-4 times/wk. Diagnosed 1/1/24 MRI, Biopsy 4/24, PSMA. 4+3, Contained in prostate 3 Opinions including Mayo Rochester render SBRT/6 mos. ADT. Have not yet made a decision. Will ultimately have SBRT but on the fence with ADT given new research findings on ADT. Waiting on Decipher test. Will make mutual decision with Mayo Care Team. Do your own research, find a center of excellence. My best!

Sounds like you have your arms well around your case and that you are approaching all of this with a very level head. The ADT decision will be a very personal one despite the results of more recent research which shows ADT for 4+3 is likely not as compelling with all the new scanning technology. Please let me know what you decide after your future consults on the matter. ADT certainly has its place but I hope you and future 4+3 patients can confidently avoid using it. I am in well above average shape and overall metabolic health at age 73 and very active. Despite this, ADT impacted my overall muscle mass, even with exercise offset and targeted supplements, etc. If I had had the new research results in 2022, I can only tell you retrospectively that the doctors would have had to give me a darn compelling argument to do ADT based on my overall situation. Stay in touch pal!

Thank you so much for your encouragement. I will stay the course and keep this blog informed of my decision making re: ADT.

@jcultra my 10.2 psa, with 3+4 Gleason, suggested using adt but the radiation oncologist I used suggested not to use it. Out of five RO’s, one suggested it. I ended up with a narrow margin linac radiation machine with a built in MRI (MRIdian). No fused images so what you see in real time is what gets treated. The 2 mm margins were lees than all other radiation types and machines vs 3-5 mm for most other radiation machines. This meant minimal exposure of healthy tissue so side effects were slight restriction of urine flow but no rectal bleeding. I had 5 hypo-fractional treatments.

Great news jcultra! You definitely were a benefactor of the latest advancements and sound collective decision-making. The Meridian protocol along with newer results on the questionable benefit of ADT for any type of Gleason 7, provided you with the very important benefit of no ADT! While rectal bleeding ney still present at some level years down the road even with Meridian, it appears appreciably less likely. You did your homework! All the best to you!