ADT with radiation?

[CBRD]

I have a G 4+3, considered to be unfavorable intermediate risk, but a Decipher score of .4, considered to be low risk. I have opted to have radiation to treat my PCa. Do I need to take ADT with the radiation therapy? My MO suggested 4 to 6 months of Orgavix (not sure if I'm spelling it correctly). If I need to take an ADT which medication has the least bad side effects?

[Tall_Allen]

Yes, 4-6 months of ADT. Orgovyx begins working most quickly and stops most quickly too.

[85236442968]

CBRD

None of the ADT regimes are with out side effects. But they do help.

I have no first hand experience with Orgovyx, but the data and posts on it are somewhat positive.

On personal note, my Gleason numbers were similar to yours and I chose radiation and ADT (Lupron and Zytiga) PSA is now at 0.04, after 5 months of Lupron/Zytiga and the Radiation. Follow up PET scan is scheduled for April 8, as I had some Lymph nodes in my abdomen that were impacted.

Good luck on your journey and keep us posted.

[CBRD in reply to 85236442968]

Thank you, and Tall Allen, for your quick and informative responses. Very helpful and comforting... Good luck on your follow up PMSA PET scan next month. BTW, how bad has your ADT regimen been for you?

[Mgtd in reply to CBRD]

Had almost the same diagnosis. I elected radiation and 6 months of ADT - 2 prior, 4 concurrent. I also elected to have the pelvic area done as a precaution to stop the cancer cells the scan is unable to measure.

I had limited side effects. The really bad SE are not a real player with just 6 months of ADT.

Honestly I felt it gave me the best shot as a cure. There is/was a study that supported ADT with Radiation.

Someone more cancer detail informed may give you the name.

Forgot to add that at 2 months post Lupron my PSA is <0.01 and my T was 233. Side effects are totally gone with the rise in T.

Good luck!

[CBRD in reply to Mgtd]

Thank you so much for your response. You mentioned that the side effects from the ADT were limited. What were your side effects during this 6 month period? Also, I'm 66 and otherwise in good health. Are we around the same age and same health conditions?

[Mgtd in reply to CBRD]

I am almost 79 and in outstanding physical condition. Resistance and aerobics 6 days a week. Hiking with my dogs daily 9 months a year.

Loss of sex drive but it is back after stopping ADT for two months. Very mild hot flashes that lasted 30 secs. Most of time prior to bed. Very mild fatigue but considering my age and level of activity that is to be expected somewhat.

Night time peeing is gone from 4/5 times pre treatment to 1/2 times a night post treatment.

If I missed anything just ask.

[CBRD in reply to Mgtd]

No, you covered them all. Thank you.

[85236442968 in reply to CBRD]

CBRD

My worst side effect is High blood pressure. Some times as high as 185/100. Cardiologist has me on 5 medications and I get about 16 good hours in a day. Edema is a pain but is manageable with compression socks and ankle braces. The Lupron will give you hot flashes for a while then they go away. All the male stuff is disheartening, but I am told at least some will return.

Everything I read is it is the best treatment regime. ie ADT and Radiation.

So on the positive side I finished the radiation and am back in the gym. Weights 3 days a week. Same with pool and whirlpool. Cardio has been tougher, restarted it once and got real bad ankle pain. Going to give in another whirl Sunday/Tomorrow.

[CBRD in reply to 85236442968]

Thank you so much for your response. When do you finish the ADT? Also, when you say SOME of the male stuff may return, what do you mean?

[85236442968 in reply to CBRD]

CBRD

Honestly not sure when it will be over, MO has not indicated when. I do tend to think it will be discussed after upcoming PET scan on April 8. This PET scan is a post radiation scan, Finished Pelvic radiation on Jan 24, and abdomen on Feb2. Have been on ADT since Oct 23, 2023.

Male issues are most ED related. I am not taking any ED meds as of yet but most likely will be soon.

[103532 in reply to 85236442968]

Hello, My husband is on the Lupron/Zytiga/Pred combo and is starting IMRT to pelvis with an expanded field to the lower abdominal lymph nodes. He had PSMA avid nodes (thankfully small still) found on PSMA pet scan. Was your radiation targeted to reach your abdominal lymph nodes as well.? Have any of your doctors given any hopeful expectations with this treatment? We have been told there are not of clinical evidence for radiation for M1a and micro metastatic disease. We are trying to give this an aggressive best shot!

[85236442968 in reply to 103532]

103532

Best wishes for your husband on his journey.

Sounds like you husband and I have a similar diagnosis. Only difference, is I also had 2 Lymph nodes that lit up in my Periaortic region.

I recieved the pelvic radiation with the expanded fields to hit the pelvic lymph nodes. Then a specific set of radiation for the periaortic region. Also have done the Lupron/Zytiga/Pred combo since Oct 2023.

Following all of this my PSA was at 0.04. Down from 9.62. So the main indicator shows that it did something. Not sure it was the Meds, or the radiation, so I will say what they prescribed for me seems to be working.

I will have a follow-up PET scan in April to see what things look like, and if anything further needs to be done soon, or if my meds are to be changed.

So now I wait. Taking my meds every day as prescribed.

Based on research and discussion I do believe it will be a year at a minimum before I know what my future will be like.

I have made it thru most of the side effect of the meds and the radiation and overall feel pretty good. I have resumed hobbies and working out, and look forward to some travel this summer, and spending a lot of time with my grandchildren.

I do not feel this is the end of the road, just a little bump.

[103532 in reply to 85236442968]

Thank you so much for sharing. My husband actually has four PSMA nodes in the retrocaval, peri-aortic, retro caval and common iliac. Nothing was visualized on the PET for the pelvis. Since he was only at a psa of 0.27, the radiation oncologist is guessing there are micro metastatic cells lurking in the pelvis as well, and he has not had any prior radiation. So, he is doing a wide pelvic field with an extension to cover the abdominal lymph nodes. I worry that this approach is too dangerous for the abdominal nodes in the area they are in, but two radiologists explained this is best….70 gy in 39 sessions. The kicker he is mapped and set to go in two days. I am praying this will give him a long remission. They are being aggressive. He is a very fit 63 year old. I am relieved it does not appear to have Mets in his bones or organs. The Lupron/Abi/Pred took him to undetectable after three weeks of starting. Thanks again!!!’

Stephanie

[vintage42]

At age 78 in 2021, I was ill-informed and allowed, if not encouraged, to decline ADT after radiation. That is might be why I now have cancer remaining in the prostate and spread to nodes. After finally starting Orgovyx over two months ago, I have no side effects from it.