Weighing the cancer risk reduction & quality-of-life cost of ADT?

I posted this for someone else a few minutes ago, but it seems appropriate for your question as well.

Your biopsy results do not look good. The PSA is low now, But knowing what it was before treatment would be more important, the decipher score is quite high. Saying that you had a chance of reoccurrence is pretty high. You don’t mention your Gleason score and that could be a major factor in what the ADT decision would be, But your biopsy results say you should be on ADT.

With the T3b, you probably should be on it for 18 months to two years. Your chance of reoccurrence is a lot higher if you don’t do that.

If you can get Orgovyx for ADT It can be real beneficial. That’s because the testosterone level comes back very quickly, for most people, after stopping Orgovyx.

3 1/2 years after I had surgery and my PSA started rising they gave me a 6 Month Lupron shot, two months before giving me salvage radiation. I had no side effects at all from that shot, Didn’t even realize I should have had any. I was only 62 at the time that may be a factor

My brother at 75 had six months of Lupron And had side effects for about nine months after, because it took a while for his Testosterone to come back. It wasn’t something he couldn’t live with. It was just annoying..

I’ve been on ADT for almost 8 years, I’m 78.. I really have no side effects that bother me. I run on the track 1 mile twice a day and go to the gym three times a week. When I was on it for the first three or four years, I didn’t do any exercises, I did run a computer consulting company and was constantly on the run, Diving under desks was a normal occurrence, I think my activities kept me in good shape. The only side effect that bothered me was hot flashes, and my oncologist resolved that with a depo-provera shot every three months. Now, After almost 8 years on ADT the hot flashes are very seldom and very light. No one I know or meet has any idea I have prostate cancer.

Just some things to think about when you consider going on ADT for a short period of time.

Quality of life is important of course. That said, part of that quality is knowing that the cancer is sleeping or being treated to not cause more harm. With T3b the potential for spread is high if not being treated. Radiation is one tool for sure and hopefully keeps the beast at bay.
The PC elephant in the room for me is the awareness that the PC was happily traveling to distant places and even though I would enjoy the benefits of testosterone, my worry for Mets would always be lingering. For that reason I opted for ADT and getting accustomed to the SE's.

@jeffmarc

Thanks Jeff. Yes, this is appropriate for my queston, so I will carefully read it and learn form it to help me make better informed decisions.

@stew80

Thank you @stew80 for sharing your your rational for deciding to get ADT and your experience with the treatment.

Sorry, in the last paragraph I meant to ask: How did folks in similar situations weigh the potential incremental cancer control benefits of ADT vs its potential harmful side effects?

It is too late to edit now, that is why I am doing the correction here.

No problem, Soli. That weighing is a personal one with variables such as the degree of cancer aggressiveness, age, health, and quality of life issues. The forum helps a lot with various experiences and in the end it's a personal choice with varied medical and independent case opinions (such as this forum) in the mix. It seems like you would opt for life quality rather than length of years. At my current age (85) I prefer longevity with minor side effects, but that's me.

I too prefer longevity with minor side effects which do not diminish my quality of life. What I do not seek is longevity with debilitating side effects which prevent me from doing things that I enjoy like traveling and socializing with family and friends.

@soli
As I mentioned, ADT is something that people don’t know I’m on unless I happen to have a hot flash. Those are something you can control. I use my wave of device since my hot flashes are so weak now.

My wife started a dinner group, There’s about a dozen of us we meet every month at one of the houses, This month it’s our turn. Everybody has a great time, Talk about lots of different things travels is one of them.

There’s nothing about taking ADT that prevents you from traveling. If you get a daily pill or a 3 or 6 month shot, You have plenty of time between the shots. I got six month shots for six years.

For Thanksgiving or Christmas, we go to my niece’s house. She’ll have 20 people and it’s always a lot of fun. Many of them are relatives, including my kids.

ADT doesn’t prevent you from doing any normal things. Some people do get fatigue but if you exercise regularly, you can beat that.

Hi Soli,
As you know we had similar scenario (minus SVI involvement ) and were considering adjuvant therapy. We had consultations with MO, RO and urologist and only RO was open for adjuvant and only because of our insistence and before first PSA result came in, so do not be surprised if your urologist does not suggest it, as you expect it to be the case. After my husband's PSA came as less than 0.014 we decided to wait and see what is going to happen. But, RO did suggest 6 mos of ADT with IMRT, IF we decide to do it.

Wishing you the best of luck with whatever you decide .

All the best for you Soli whatever your decision.
I had/have aggressive PC so started Lupron (0.22 shots) every 3-months (after RALP Jan '22) for 2-years. Jan '22 to Jan '24.
I still have some hot flashes but usually only I know.
Strength and energy are coming back slowly with exercise.
I'd do it again if (when?) I had to.
Once you decide, don't look back.
Write a good future for yourself!!!