IBRT/SBRT Radiation and ADT

[805guy]

I have heard so many horrifying things here about adverse reactions to those who were prescribed ADT in conjunction with or shortly after radiation treatment. Has anyone forgone taking ADT therapy or does that ruin any progress made from radiation? I have read there is no evidence ADT actually improves or changes outcomes in those with unfavorable intermediate grade 3 prostate cancer (like me). I am now absolutely terrified of taking ADT after everything I have read and heard from others about their experiences. Any thoughts about my perception or am I completely wrong about it? Thanks.

[Tall_Allen]

Short-term adjuvant ADT should have no lasting side effects - what is it you've read on here?

I don't know what IBRT is?

4 months of adjuvant ADT improved results in unfavorable intermediate risk men treated with IMRT:

prostatecancer.news/2020/09...

redjournal.org/article/S036...

ejcancer.com/article/S0959-...

pubmed.ncbi.nlm.nih.gov/250...

prostatecancer.news/2018/03...

prostatecancer.news/2016/08...

nejm.org/doi/full/10.1056/N...

The benefit with SBRT is being explored in this clinical trial (results expected next year):

classic.clinicaltrials.gov/...

There is a new AI service, called ARTERA AI, that personalizes the prediction of benefit of adjuvant ADT. You might want to ask your radiation oncologist to contact them:

artera.ai/

[805guy in reply to Tall_Allen]

I meant IMRT. So many acronyms.

Thanks for the links. This is very helpful, as usual. You have been a great source of information and it is very much appreciated.

Re: ADT, I have read on here and in other sources about the usual side effects but have also heard about penile shrinkage, mood swings, heart attacks and no recovery of testosterone or libido. As a gay man, those are major fears of mine.

Btw, I consulted with a UCLA radiology oncologist. Overall, good meeting however I wasn't terribly keen on his suggestion of 18 months of ADT (!) because of my PSA score of 21.5 (second score 2 weeks after initial 19.76 PSA before my physical) or his perceived downplay of using SpaceOAR during radiation. Nevertheless, he suggested a decipher risk test to help determine ADT treatment. I would prefer not to even do ADT given I have read there is no evidence it makes a difference with intermediate unfavorable grade 3 prostate cancer. I am considering the clinical study you recommended to me about a month ago. I will definitely look into the utilization of ARTERA AI and recommend it to the oncologist I work with if I do not participate in the study.

[Tall_Allen in reply to 805guy]

You are only having temporary adjuvant ADT, so whatever you've read does not apply to you.

If your PSA is 21.5, you are not "unfavorable intermediate risk," you are "high risk." I don't know why you imagine there is no benefit to adjuvant ADT. I just provided links showing there is certainly a benefit, even for unfavorable intermediate risk. For high risk patients like yourself, there is even greater benefit.

You are also mistaken about the need for SpaceOAR. It is problematic in high risk patients because it can protect extensions of the cancer from receiving radiation. If you will be treated on Viewray at UCLA, there is no benefit on rectal toxicity anyway. Dr. Kishan did the randomized trial and can explain it.

[805guy in reply to Tall_Allen]

I guess I am really confused by much of what I have read or heard and that has influenced the perceptions I have formed to date. Yes, the UCLA oncologist did refer to my condition as high risk, yet when I received my diagnosis from my urologist, I was told I was intermediate risk unfavorable. I guess my personal situation will all become more clear as treatment is determined. I was under the impression "temporary" adjuvant ADT meant 4-6 months but I suppose 18 months is also considered temporary. I just hope treatment of that duration does not have permanent side effects. I will find out.

[Tall_Allen in reply to 805guy]

Your cancer became high risk when your PSA exceeded 20 ng/ml.

[Hidden]

just look up the side effects of low testosterone. Having had Low T for my whole life, I can tell you that I've felt like a normal person with Testosterone replacement. Being off TRT, my T levels are below castration level. I've had depression, fatigue, increased cholesterol levels, loss of sex drive, loss of muscle mass, increase of body fat, hot flashes, larger breasts, loss of erections, insomnia, generalized brain fog and osteoporosis. Those are the side effects prior to going on Testosterone replacement and again since coming off of T replacement since my diagnosis in December. I am now also susceptible to heart disease, diabetes and stroke. The point of ADT is to get your Testosterone level below 50 or castration serum level with the idea that low T will diminish the cancer growth. My last T level was 38. That was 5 months after removing Testosterone replacement. It was suggested I go on ADT for 4 months, I think, and I adamantly refused. I am currently getting salvage radiation 4 months after my prostatectomy without ADT. Its a choice I made. The medical oncologist said the ADT could improve the chance of getting all of the cancer out by 5%. I can't imagine how I would feel if my T level went down from 38 to 0, but I imagine it would be worse. Its just a personal choice I made and you should to after getting all the facts. Will the ADT make any difference? Are you willing to deal with the effects of Low T? It is only for 4 months, so the risk might outweigh the side effects. Once I complete radiation and my PSA is undetectable, I will be going back on T replacement, with or without a prescription. Thats how strongly I feel about it. Prostate cancer doctors don't care about how you feel. They only treat prostate cancer. To them, ADT is beneficial for saving you from Prostate cancer. Unfortunately, they don't care if you die of stroke from Low T.

[EdinBmore]

As noted above, each of us reacts differently to ADT and there are different standards of care regarding when and how long to continue taking it. I received IMRT, brachyboost, AND ADT. I think I handled the radiation relatively well; not so much with the ADT. Even though I had read and searched the internet for info about its side effects, I had no idea of how badly I would react to extremely low T (my normal is low: 240s) as a result of ADT. My docs recommended 3 three mo injections. I didn't fully recover from the side effects for about 15 mos. I was unlucky. Btw, a close friend also has PCa and has had virtually no side effects other than minor fatigue. So, go figure.

Would I take ADT again? Honestly, I do not know. Good luck.

EdinBaltimore

[dans_journey]

Not a direct comparison, but I had a radical prostatectomy that failed and had biochemical recurrence which led to 35 sessions of salvage radiation therapy that was done with concurrent ADT.

Each person's response is unique, and I believe I was one of the lucky ones when it came to the ADT.

I was given a 6-month dose of Eligard two months before the radiation started, and the initial side effect was mild fatigue. Later, I found that I was more emotional than usual. But I didn't have any hot flashes, nor any weight gain. My libido was down slightly and I suspect there was some muscle loss as well.

It was the radiation that had a greater effect on me. About halfway through my 7 weeks, the fatigue really kicked in (on top of that from the ADT) and a definite increase in urinary frequency and urgency.

It's been a year since I completed the radiation and about 8 months or so since the Eligard wore off, and I'm pretty much back to where I was pre-SRT and ADT.

Again, we all respond differently and there's really no way of knowing until you actual go through the treatment. Good luck with your decision.

[805guy in reply to dans_journey]

Thank you. I appreciate your response and hearing of your experience. Still waiting to determine my course of action next week.

[805guy in reply to dans_journey]

Can I ask what was your psa at diagnosis and Gleason score?

[dans_journey in reply to 805guy]

Hi. My PSA was 5.0 ng/mL and my initial Gleason was 3+3, however, it was upgraded to 3+4 in the post-surgery pathology. I was 52 years old when diagnosed.

My PSA just before getting the ADT and radiation was 0.36 ng/mL which, for a post-surgery patient, is pretty concerning.

[805guy]

My psa was initially 19.76 and then 21.5 on the second check. 4+3, Gleason 7, intermediate unfavorable. How long after radiation were you tested for psa? Was adt started immediately? It was recommended by one oncologist sbrt and 18 months adt.