Quick question.
Let's say that you have Mets and don't know it. You think the PCa is contained because our last Pet-scan 2 months earlier said so. Are we wasting time going onto ADT if that treatment is mainly for contained PCa? Or will the ADT put a lid on the Mets wherever they are in our body?
Keep in mind that we are totally oblivious of having Mets at the time of starting ADT.
The primary use of adt is to stop cancer from growing wherever it may be, particularly if it has spread away the prostate itself. It is called systematic treatment.
Some patients have a course of adt along with radiation because it weakens the cancer and makes it easier to kill with the radiation.
I dont know if that answers your question.
Yes it does and thanks for letting me know this, I will probably repeat this reply to a few others who have replied. This is all a learning curve with me and so these answers are adding to my limited knowledge of this complex subject.
What makes you think that ADT "is mainly for contained PCa."
Ok, so in my very limited knowledge, I have noted on this forum and elsewhere that the SOC for metastatic PCa is what is called Triplet therapy, or at least ADT with Chemo as an important addition. So I concluded from this form of treatment that ADT is not enough on its own to positively effect the Mets. Am I wrong in thinking this? Hence my query, that if you don't know you have Mets, are we "wasting" (probably not the right word) our time just following the SOC for loacalised PCa? - It appears as though I am way off the right track here, but I'm sure you can get what I am saying.
ADT is the primary ingredient in any medical therapy. Yes, it's not the only ingredient, if that's what you mean.
What is the risk classification of your localized cancer?
Not sure what you mean by risk classification. My GS is 4+4, a Psa of 8. So I guess I'm in the lower end of the high risk category.
""The risk groups defined by the NCCN guidelines were as follows: low risk: T1–T2a, Gleason score ≤6, and PSA 20 ng ml−1; very high risk for locally advanced prostate cancer: T3b–T4 or primary Gleason pattern 5 or >5 cores with Gleason score 8–10; and metastatic risk: N1 or M1 with any T stage.""
journals.lww.com/ajandrolog...
The cancer is high risk having a Gleason 8.
You had radiation treatment.
IMHO, in your situation I will finish the course of ADT indicated by the RO. You have a chance of cure , if you miss it, it will be ADT for life. There is not a 100 % guarantee in this game but you increase the possibility of getting cured doing the whole course of ADT.
You should not forget that there is not an imaging technique which may detect metastases smaller than 3-4 mm, unless you got to the Netherlands to the Radboudumc and get a combidex MRI with ferric nanoparticles. It won't identify bone mets.
My understanding is that ADT slows the growth of prostate cancer cells whether they be in the prostate, or in mets to soft tissue or bones, whether detected or as yet too small to be detected. I was told that my PSMA-PET scans have a threshold and I could have many micro-metastases that they cannot detect yet.
Yes I'm starting to learn this now. I guess they only add Chemo once they establish some definitive Mets where ADT needs some help.
"I guess they only add Chemo once they establish some definitive Mets where ADT needs some help."
I have read that chemo is added early for triplet, or used alone late.
Early: for newly diagnosed hormone-sensitive cancer, can have spread to other parts of the body but can be treated with hormone therapy. Triplet therapy usually will not be suitable if you have been on hormone therapy for more than 12 weeks, or if you have already started chemotherapy treatment, or if you have already been given darolutamide, or another new (second-generation) hormone therapy such as, enzalutamide, apalutamide, or abiraterone. prostatecanceruk.org/prosta...
Late: when ADT no longer works (i.e. you are castrate-resistant), plus you have bone mets.
FWIW, I had no idea my cancer had metastisized until I got the results of the bone scan.
ADT lowers testosterone which then causes reduced growth of PC cells throughout the body. However, reduced growth does not mean no growth, and there are some types of PC that are not sensitive to ADT. Since testosterone is not reduced to zero, PC growth is not reduced to zero. Therefore, it is best to keep wary, watch PSA like a hawk. Watch diet for things that increase or decrease PC growth.
maybe get a PSMA ct scan if your PSA rises above 0.20 best available tech now
I've had a petscan and shows no Mets. That was a few months ago. So who knows whats happened since then. But your point is taken,
It's impossible to answer such a general question because every case is different, but Gleason 8 puts you at high risk for metastases.
Don't fall for the myth that "the PCa is contained because our last Pet-scan 2 months earlier said so". A negative scan just means that whatever tumors you have are not yet big enough for the scan to pick up. When the cancer first spreads, it won't show on a scan until is has some time to grow bigger.
Yep and that was my point. ADT only really is not going to cut it for high risk guys like me.
Or is it?
If only the Pharma's came up with a milder ADT drug mixed with a milder Chemo drug that would do the job or eradicating this rotten beast. By milder I mean less damaging to our QoL but still good enough to track down those rogue cells and kill them off. Maybe they could add in a drug that at the same time stimulated our own immune system to offer a boost to do all the mopping up.
Fantasy maybe but I bet one day that will happen. Thanks for your answer.
When I was 66, my athletic body tolerated docetaxel pretty well. That plus prophylactic radiation of abdominal lymph nodes (scan showed no tumors) gave me another 4+ years of undetectable PSA without ADT.
Personally I'm trying my best to delay/avoid ADT because it gave me the worst side effects of any treatments I've had.
"... trying my best to delay/avoid ADT because it gave me the worst side effects of any treatments I've had."
I delayed/avoided ADT until a scan showed cancer remaining in the radiated prostate and spread to two nodes. I began Orgovyx over a month ago with no side effects. I wish I had started it when it came out in 2021.
Just read your BIO. wow, you have thrown everything at your PCa and by all accounts it looks like its been quite a good run without any major SE's apart from some you had with HT. I really hope you keep on going well and get another 20 years!!!!
Life continues even on ADT.
weight gain, ADT and diet
dilemma ADT duration 
Surgery+radiation+ADT orRadiation + ADT
Ruminating on Extending ADT&Zytiga beyond 18 months
