Stopping ADT During Salvage Radiation - Prostate Cancer N...

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Stopping ADT During Salvage Radiation


I am due for another 3 month adt shot on 5-20. I have lost ten pounds mostly from muscle lost since beginning adt in February. I go to the gym 6 days a week which helps with side effects. I had two days where my blood pressure dropped 16 points I don't know if this is related to adt use.

I had two RO's recommend hormone therapy but from most of the studies I have seen shows little benefit of adt with a low psa and low decipher score. I am thinking about not taking the next shot or changing it to one month for a total of 4 months of adt. Is there a benefit of taking 4 months instead of 3 months even if the benefit of adt is small? I have completed 8 srt treatments so far.

My last psa was .16 before starting srt . Pathology 95 percent G6, 5 percent G7, 3+4, two psm's highest gleason score at margin was G6. Surgery was in 2016.

5 Replies

ROs love giving ADT indiscriminately of PSA. They also love badmouthing PSMA PET/CT at low PSA. Both affect their comfort zone. I am in similar position as yours, but I have my own agenta. Will wait until PSA reaches 0.2. Start Casodex in the hope that it will stimulate PSMA excretion for the scan to follow (it is within a clinical trial and they go by the book, ie BCR=0.2). Will keep taking Casodex during eSRT if SE are tolerable. Luprolides and such, out of the question.

Data suggests that ADT does not increase the benefit of SRT when PSA<0.7. This is especially true with your positive margins, low Gleason score and low Decipher score.

Ab75 in reply to Tall_Allen

Thanks for the information.

My Experience: (I am 77 and living in Toronto)

Gl went from 3+3 to 4+5. Prostate Onc got very concerned. Referred me to Radiation Onc.

Goal: to reduce testosterone (T) level to Zero to make 40 planned radiation treatments more effective.

Sept/18. Started 30 days of Bicalutamide (Casodex) and first of 8 planned 3-monthly ADT (Zoladex) injections.

Rad treatments were supposed to start in Dec/18 but bladder problem postponed it to Apr/19.

By this time, PSA decreased from 19 ug/L to <0.02 and T level down from 8.3 nmol/L to <0.4.

(In U.S. terms, 1 ug/L = 1 ng/mL and 1 nmol/L =~11ng/dL)

40 planned rad treatments reduced to 25: 5 days a week for 5 weeks at 68Gy.

Finished rad in May/19.

Combined side effects (SEs) of hormone injections AND rad treatments PLUS medication (cyproterone to reduce hot flashes) (and SEs continuing even now) are HORRIBLE, but better than the alternative: dying from prostate cancer.

Rad onc agreed with me that my continuing low PSA/T levels eliminated the need for the last two ADT hormone injections. Yea!

The Zoladex injections were time-released over each three-month period.

I am now 3 1/2 months since the last injection and still suffering SEs, but expect these to diminish over the next three months. Might take six months, or even a year (or more).

My PSA is still <0.02 and my T is still <0.4. Next blood test is in a week, but I expect no change in those numbers. I will be monitoring every three months at least for the next year.

Bottom line, AB75, is that I was given the Casodex/Zoladex to lower my T level to make my radiation treatments more effective. If your Rad Onc is suggesting ADT for the same reason, you should obviously go with it.

Hope this helps and gives you a different perspective.


Ab75 in reply to Monitoring

Thanks. Good luck to you.

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