ADT or Not?

[bagspacked]

I am new here. I am 60 years old and work full time as an engineer. I was diagnosed with prostate cancer last August and set on Proton therapy. The doctor recommends ADT for 3-6 months prior to, and during my proton treatments, and says it will increase effectivity by 20-25%. But I am reading horror stores about ADT and still can't identify how long it takes to get back to normal. I am tempted to forego ADT and get right into proton treatment. I want to know what this 20-25% edge means. Does it mean that the proton treatments may not work and I would need more? Or does it mean the cancer eventually spreads? Has anyone here done some form of treatment with or without short-term ADT?

[Tall_Allen]

You didn't mention your risk level. For favorable risk PC (low risk or favorable intermediate risk), ADT probably won't increase the effectiveness of any kind of radiation. For unfavorable intermediate risk, only short term use may be necessary; for high risk PC, long term use is necessary.

[AlanMeyer Moderator in reply to Tall_Allen]

To elaborate Tall_Allen's response, here's my understanding of risk levels:

Low risk = Gleason 6, PSA < 10

Favorable intermediate risk = Gleason 3+4, PSA < 20

Unfavorable intermediate risk = Gleason 4+3, PSA < 20

High risk = Gleason 8 to 10, PSA >= 20

If one of your criteria is in one category and the other in a different category, e.g. Gleason 6 PSA=15, it may be safest to consider yourself in the higher category - in this case favorable intermediate risk. You should also be aware that when a prostate gland is surgically removed and tested, it is not uncommon to find that the Gleason score reported on the biopsy is lower than that found in the excised gland.

I'll say something more about ADT in a separate response.

Alan

[Tall_Allen in reply to AlanMeyer]

The NCCN definition is a little different and also includes staging.

Low risk = GS 6 and Stage T1c/T2a and PSA<10

High risk = GS 8-10 or Stage T3a/T3b/T4 or PSA>20

The NCCN intermediate risk group is currently defined as having any of the following:

- Stage T2b or T2c, or

- PSA 10- 20 ng/ml, or

- Gleason score = 7

(If multiple risk factors are present, the clinician may optionally deem it high risk)

Unfavorable Intermediate Risk:

- NCCN intermediate risk, as defined above, plus

- Predominant Gleason grade 4, or

- Percentage of positive biopsy cores≥ 50%, or

- Multiple NCCN intermediate risk factors

Favorable Intermediate Risk:

- NCCN intermediate risk, as defined above, but only those with

- Predominant Gleason grade 3, and

- Percentage of positive biopsy cores <50%, and

- No more than one NCCN intermediate risk factor

For example, a man with GS6 in 4/12 cores, Stage T1c, and PSA=15 is favorable intermediate risk.

[SantaZia]

Bags there is no treatment option that is best for everyone with Prostate Cancer. Once you have all the facts on the stage and grade (PSA, Gleason, tumor grade, genetic aggressiveness, health history) you will be able to select a treatment option using clinical trials and mega study results. I wouldn't be worried about ADT. If you are intermediate unfavorable or advanced you will increase the odds of the cancer being killed and not coming back. Use your engineering skills. Good Luck!

[Dreamweaverman]

Hey Bags, I am on my 2nd month od ADT, and I actually dont feel side effects that much. My stamina is a little less but my ability to power through a workout is still strong. While I am sure ADT side effects can be different for everyone, most guys whom responded to my posts about fears and concerns with both ADT and RT have had little side effects. If you choose ADT, I hope this will be the case for you too. Good luck.

[PGDuan in reply to Dreamweaverman]

Similar here. I started in November and was in top shape at the time. I’m now a little slower, but still feeling good most of the time and continuing to do all the same activities. Hasn’t been as bad as I feared.

[Hidden]

Not an easy answer without knowing and understanding your risk level as Tall_Ellen noted. That is brilliantly laid out in the Lewanda video [youtube.com/watch?v=WmWsi_B...(Not working as expected?)] also in Scholz' Key to Prostate Cancer. As an engineer you probably welcome data and some complexity to the calculus--or, maybe not. ADT is demonstrably better coupled with RT. But it depends on your age, your risk level and your willingness to accept side effects. Talk to more than one man about his side effects. I have found in our support group in Providence RI that there was a wide range of side effects and their impact on the lives of the men taking them. One man was on a similar six-month course before surgery. After RP he decided to exit the study as the mental fogginess, the weakness, the loss of muscle, the growth of breasts, the absence of sex drive and the depression were more that he would accept. That was his decision based on his experience. Other men whom I have interviewed actually needed prompting to remember the side effects: "Oh. Yes. Now that you mention it, I did have hot flashes. That was a long time ago." "O. Right. I did grow boobs." Dreamweaverman (below) has not noticed much, but it is early days and the side effects for some men worsen rather than improve after months of treatment. Think before you leap. My experience is that oncologists are good smart people but with only one metric: survival-months. They do not have to live the side effects. Some care; some do not care about what the patient endures. And good luck.

[AlanMeyer Moderator]

bagspacked,

ADT is bothersome. Most men don't like it. I had it for four months before and during my radiation treatment and a while afterwards. I was 57 at the time. I most disliked the complete loss of libido. I also disliked the hot flushes and the reduction in physical condition - which I countered with partial success with exercise. About 5-1/2 months after the first Lupron injection it felt like everything had come back, though I had a surprising after effect of joint pain in fingers and toes which I managed pretty easily with heat/cold and exercise until it too went away.

If the ADT will improve your chances of a cure, I recommend that you take it. Death by prostate cancer is worse than ADT. If you really can't stand it, you can always stop taking it and, after a while, the effects will wear off. If you want to make it easier to back out, ask for a 30 day injection instead of a 3 or 4 month injection. However you probably want at least 3-4 months to get real benefit from the drug and, depending on the risk level of your cancer, it may be more than that.

Best of luck.

Alan

[MelbourneDavid]

With radiation you really only get one chance at a cure - you can't do more or do it again. Salvage surgery after radiation is possible but very tricky and I expect damaging.

I'd take the radiation oncologist's and AlanMeyer's advice and take the ADT with monthly shots (the recovery afterwards is faster). Experiences of ADT vary widely, but treat it as a part of a relatively low-impact treatment (you avoid surgery's months recovering continence and hopingfor erectile recovery) and you'll be in a good position unless you have a really unusually bad reaction.

[RonnyBaby]

ADT can be used to shrink the prostate in size.

When you are treating it with 'rads', it is better if the target size is reduced.

I personally had a very bad experience with ADT, but I could tolerate ONE or TWO 3 month

injections to HELP ensure the treatment is as effective as possible.

It would require a very good sales job to get me to go further than that.

Been there, done that - I would consult my 'doctor' to find out WHY they are offering it to you.

IF it would be beneficial to you, then you should go for it THIS one time

(one 3 month shot ?).

IF that is all the ADT you need, be grateful - many men don't handle ADT well .....