CV and Bone Health when ADT is a treatment option.

[Hawk56]

Thought this provided a useful framework to guide discussion with my medical team when discussing whether or not and what to do about CV and bone health when starting on ADT.

urotoday.com/conference-hig...

[London441]

How much do you exercise and what kind? Unsurprisingly no mention was made of it.

[Hawk56 in reply to London441]

I exercise pretty much every day.

If it's the gym, 45 minutes on the indoor bike, weights and 20 laps on the pool (1000m).

Outside when I ride my bike, 25--45 miles.

I play pickleball with friends, then there's yard work, mowing, yesterday I put down five cubic yards of mulch...

I usually ski once a year in Colorado and we'll use take a summer vacation there and hike.

Kevin

[London441 in reply to Hawk56]

That is great. I see you have had quite a ride, and have been thorough in your pursuit of optimal treatment. What is your status currently? When did you have your last Dexa scan?

[Hawk56 in reply to London441]

When we met with my radiologist and oncologist on 4 April, the question was whether to come off Orgovyx after 12 months or do another six.

My radiologist supported 12 months, she said at the weekly meetings where an integrated team of medical specialists reviewed treatment plans, oncologists were all over the map about time on ADT, they just didn't know.

My oncologist was an advocate for another six months, no specific data, just his "gut" feeling. I mean, hard to disagree with his training, education, experience....

We talked aboutrisk-benfits of 12 vs 18 months.

Oncologist had no clear and specific data about the benefits, difference in PFS, OS, RPFS...for my particular case.

We discussed the risk of becoming castrate resistant, again, I had no clear data, neither did he.

So, we decided the risk of castrate resistance may be greater than the unknown benefit of another six months and agreed to come off treatment. There was one proviso, we would do labs and consults every three months, image if (well, when) PSA began to rise and went above .4. My oncologist said he would add the ARI in that case to Orgovyx and SBRT if that was possible based on the imaging results. Too easy I said.

As a side note, he did not add Xtandi this time as he felt the Orgovyx which had dropped PSA from .77 to undetectable in less than three months was not needed, this time. I know, doublet therapy, EMBARK trial..

I've learned in these 10+ years that there is the science to this, NCCN, AUA guidelines, CTs...but the art is how to apply the science, which may be standard of care, albeit population based to my PCa.

I have rules for myself, these are two of them...

"I educate myself as completely as possible and take the time I need, I always know that no matter the outcome of a particular choice, I make the best possible decision. That knowledge that I have thought my decisions through carefully is what is really important—and may be more important than the decision itself.

Once I make an informed decision and carry it out, I never look back. Well, that is not entirely true, I look for lessons learned from that decision. The path is always forward: I continue to learn about PCa and always look ahead. What counts is today and what lies in the future.

Yesterday is gone, so forget it, well, learn from it.

Kevin

[London441 in reply to Hawk56]

I made a somewhat similar decision around ADT, and so far glad I did.

What about that Dexa scan history?

[Hawk56 in reply to London441]

Had one in July 2024

Based on the World Health Organization Guidelines, Bone Mineral Density values show normal density in the lumbar spine and proximal femurs.

FRAX Assessment: Not reported, as all values are in the normal range and the patient has a history of fracture.

[London441 in reply to Hawk56]

Good. Keep lifting. Sometimes I don’t like doing as much cardio as I do but then I remember the number of CVD deaths in men in the US per year (near 800k) vs prostate cancer (33k). More of my friends have stents and bypass surgeries than I can count.

Your diligence in both your investment in your treatment path and life habits bodes well for you, well done.

[maley2711]

Thank you for that...informative. Wonder how applicable to men doing RT +ADT for 6-24 months ? 1st Lupron shot today.....28 sessions RT starts in 2 weeks....18 months ADT and osteopenic pre-treatment.

[Hawk56 in reply to maley2711]

What was interesting to me was the use of a prior MACE event and FRAX scores to guide decision making, say, whether to have a bone density test at the start of ADT rather than a standard everyone who's staring on ADT gets one...

[CousinGrandpa]

thank you for sharing this. I’m just starting adt.