Intermediate-Risk: Do You Need Hormone Therapy With Radiation? |  

Although I appreciate and applaud your aerobic exercise efforts the real key to overcoming side effects of ADT is resistance training.

70 also. Waiting for my biopsy results.

70 as well. One 3+4, others 3+3, psa 7.12. I chose radiation only. My RO aggreed stating we could start HT down the road if needed.

@@davewilton3101 Best wishes for a successful treatment journey. A bit surprised that even with 3+4, you chose treatment as opposed to AS...To the larger question, I have to believe that many urologists and oncologists are marketed to do by pharmaceutical interests to promote ADT.

Good luck for a successful journey, whatever road you take!@@keithcolegrove2924 G

Any side effects from the sbrt?? Ed etc

I'm with you, John. Still on ADT's, but angling to get off. Would rather continue with strict lifestyle changers and the non-stop exercise, etc.

Thats shocking to hear about your friend and tragic and scary. I was offered surgery but don't like the high % of possible side effects, i have 3 cores 3+4, highest core 20% 4, and 1 core 3+3 left and 3+3 right, psa 8.8. Iam looking into getting nanoknife or hifu, or if i can't get them then seed brachytherapy, but no ADT i will take my chances without that. Sorry to hear about your friend, so sad.

@@hyway62 Thank you for your thoughts. My friend was a fellow Veteran, 58 years old and healthy otherwise. I think his urologists talked him into surgery, and he was scared to question a doctor and now he is gone because of it. Just had his first grandchild. What a tragic loss. I wish everyone could see Dr. Scholz and PCRI. Good luck with your treatments. Do what's right for you and be satisfied with your choice and just enjoy every day!! Life is a gift.

Did your friend get robotic key hole surgery, did u get LDR seed brachytherapy and u have only urgency as a side effect?

⁠@@hyway62 My friend got the robot assist surgery. I got LDR brachytherapy and just had some loose stools after the procedure. I’m up once a night now to go to the bathroom, and during the day go quite frequently.

I had thought that it was either/or with Brachytherapy and some form of external beam radiation. Interesting that you were suggested both.

Right away they want to give you hormone treatment.Because it's extra money for everybody involved. I just can't get my head wrapped around the idea that they would take testosterone away which is a very helpful thing for your body to have. They take it away and it makes you sick. W t f. I don't believe cancer feeds off Testosterone. That's what they want you to believe. T o sell you hormone treatments 4:20

What were some of the effects? I’m thinking about getting it.

@@troyelam8978 Hot flashes day and night weight gain and joint pain!

Best of luck!! I don't know where you are located but go see a sexual health doctor before you start. The doctor has penile therapy that can lessen your symptoms from radiation. I don't know what they are but my husband is starting radiation in a few months. We just went to the doctor today. We should have been there 2 years ago before he had prostate removed.

I can empathize with you. Would like to go back and change my decision on ADT too. It's ruined my life. Best wishes.

Of this comment.I am leaning towards surgery. I would rather put up wearing a diaper then suffering through the hormone treatment side effects. In fact today I wore a diaper around the house to see how it would be. Not bad at all. Now, Nine times might be a lot worse. Cause I pee a whole lot. What........ I need to get a rubber mattress covor to protect all the pay that the diaper does not collect ?! I'm serious.

@@ricknowak4582 the adt has little to do with radiation or removal. It’s about the possibility of microscopic spread having already occurred. ADT is like insurance and makes the tumor more receptive to the radiation. I did 28 rounds of imrt with 6 months adt a year ago with no regrets. I started with pirads 5, Gleason 7 4+3 and psa 9.7. Now psa at 0.2.

I think It's all about money to the pharmaceutical companies. Especially the company that makes.... l u p r o n. Can you imagine how much money goes to these pharmaceutical companies. I don't even believe that testosterone feeds the cancer. I don't believe it. Why would they take to stostern away from you. When it keeps you healthy. To fight cancer you have to be as healthy as you as you can.

How does genetic testing predict if your lesion is going to grow very slowly or not? Just curious because iam 3+4 in 3 out of 5 cores highest core was 25% 4, and 2 cores 3+3 left and right. Iam thinking of doing Active surveillance on the 3+3's and getting nanoknife or hifu on the 3+4, thanks for your comment its very helpful

It seems that we both had the same PSA ( 4.1) and Gleason 7 ( 2 out of 12 specimens ) . Mine was 3+3 in one specimen and 4+3 in the other RZTM . May i ask if your was 3+4 or 4+3 ?

I don’t know about dying from the complications of ADT or hormone therapy, but I thought that in increased the thoughts of and/or likelihood of suicide? Not sure about that, but please comment if you know more on that

@alanaldpal950 Same here.

Rising psa isn't the end of the world, a lot will depend on your mri and possible biopsy, but we all know what your going through, its tough stick with it, there is light at the end of the tunnel

I doubt anyone has died of ADT. Women live their whole lives with low testosterone. I know one older guy whose testosterone never recovered after Lupron…it’s still low. I’m on orgovyx and other than lower energy I don’t notice any differences.

2 1/2 years ago I had 12 cores taken and 8 were positive. All were Gleason 7,2 were 4+3 and 6 were 3+4. At age of 65 I choose radiation and had 42 sessions. I was not going to do 6 months of HDT because of side effects. They talked me into doing it and I think HDT is why I got my ED problems. If I was to do again I think I would have passed on the HDT after seeing this video about the study.. Mine wasn't too bad , had hot flashes and was tired. Could care less about sex. Good luck with everything.

Did you receive Proton Therapy?

@@dr.mickeyjones5822 No I am currently doing IMRT

just received a Gleason 3+4=7 in 4 cores right side 3+3 in 3 cores left side PSA 5.2 PIRADS 4 havent gone with a treatment plan yet , probably go with radiation seeds , no hormone therapy , also wondering if its worth looking outside of Canada for more effective less evasive treatments ? i know it would be expensive but less side effects might be worth it !! So what kind was the 28 radiation treatments you are recieving ? im 58 yrs old

​​@@markfitz-george1938brachy done right IS the most effective & least harmful curative therapy. Focal therapy has less side effects but is not more effective .. may buy you time if that's what you're looking for.

Just had my first psa 3 months after first treatment. My psa on first day of treatment was 13.4, doc said it should be roughly half after three months and it went down to 7.6. So all is going well and I feel great

I am in the same boat as you. I had a prostatectomy and it also metastasized to my left pelvis as well. I took one shot of Lupron that lasts for 3 months. I am almost at the 3 month mark and am almost done with radiation treatment. I had 10 radiation sessions on the tumor in the pelvic area and will when done 40 on the prostate bed area. Right now my psa is

It is entirely your choice. As long as you get full disclosure about ALL the horrific quality of life destroying and life shortening side effects and carefully weigh those against the small hoped for benefits. Unfortunately, most doctors obfuscate the long term and often permanent partial or full CASTRATION. Testosterone recovery may take more than five years, and more often, low T is a permanent result of this cruel and barbaric treatment

Same for me, one year Lupron. I have all the problem of Muscle and bone loss. Never had dental issue all my life, now having cavities. Extreme fatigue and VERY bad sleep- up every hour.

Thank you for sharing. Please reach out to our helpline at PCRI.org/helpline if you need help or further information. We know this is a lot to go through and we just have to say you are amazing.

How does genomic testing predict if u should go on ADT??

@@hyway62 Not a Dr. - but genomic tests like Decipher help decided on a treatment plan, dual modality.. I did both Decipher and Polaris(?) - both showed that I was right on the edge of needing both. I choose to pass on ADT

I see u got SBRT any bad side effects with that, like ed or low or no semen

@@hyway62 I believe seminal fluid is produced by the prostate, my prostate is dead, so very little ejaculate. I had lite ED before, but morning viagra takes care of that..

I am assuming you still have a prostate? If so, do not worry as a recurrence would be defined by a rise to > 2.1 ng/mL (per the Phoenix defition). It is normal for the PSA to bounce around a bit when you still have a prostate left. A rising trend of two or three levels in a row would be cause for concern. Don't stress over one level.

@@elitetrader5468 Thanks for your response. Yes, still have a prostate. What you said is reassuring. Thanks.

That is a great question. I’d guess that given the threshold level required for PSMA avidity, the docs have to guesstimate on chances of micrometastatic cancer escape from the prostate…and 4+4 might be too chancey for many docs.

Prostate cancer is a multifocal disease and other areas of the prostate develop other tumors that can be higher grade. Or somebody can have a 3 + 3 that was underread. But pure 3 + 3 tumors do not metastasize nor do they change into other forms.

Very sorry to hear that...I am getting ready to start radiation in 2 weeks....Scared of that side effect.. Prayers for you sir

Gleason 4+3 = 7 = Grade Group 3 which technically places you in the Unfavorable Intermediate Risk Group. What I will share with you is I had an initial meeting with my Radiation Oncologist ( on biopsy I had 12 cores done, 1 was 3+3, 1 was 3+4 and 2 were 4+3) As part of my staging work up I have a PSMA pet scheduled in a month and this next part will be of interest to you and others as I had not heard of it before. He is sending my biopsy slides off to be evaluated by ArteraAI Prostate test ( you can Google search it for all the details). Basically it determines if you are AI biomarker Negative and thus may not require short term androgen therapy vs AI biomarker Positive who may greatly benefit from short term androgen therapy. The AI determines the 34% of individuals that may greatly benefit from short term androgen therapy. My RadOnc told me if my test comes back AI negative then he would not recommend androgen therapy. This test along with the study that Dr. Scholz speaks to in the video can be a part of your shared decision making process with your treatment team, but you might have to prod them or alert them to it, as they may be unaware. I would also pass along to you, to do your research and check out other PRCI videos, those from the Univerisity of California system and other high quality ones. Try to build a good team with a Urologist, Radiation Oncologist and Medical Oncologist to help guide you. What I'm learning, if you don't have a Medical Oncologist on your team as the honest broker, you can get siloed in Urology or Radiation oncology and not be aware of all of your choices. And as surprising as it might seem, some of the specialists are not up on the latest changes and best / best emerging practices. To me, given your single 4+3 core on biopsy (putting aside the 3+3) and PSA of 4.1 you have time to research, get multiple opinions. Don't rush it. You only get one shot at your best first course of treatment. Hopefully, your team is going to have the Decipher or similar test done to help in your decision making. I would think if your Decipher were a 2.1 or a 8.1 it might influence your choice of treatment. You might be a candidate for focal therapy. I don't know if you are just locked into the radiation pathway or not. I also note you only speak to a bone scan. Hopefully, they also performed some type of CT or Tc99m scan? With your low PSA and a single 4+3 core, doing a bone scan alone would be a head scratcher. I would reengage with your team and even if you have to travel to another city, get a PSMA PET/CT during your staging. As your future surveillance scans should you go with radiation therapy should / will be PSMA PET. Recent high quality study, Mar 2020, (focus on high risk not intermediate risk, newly diagnosed prostate CA) in the Lancet - proPSMA clinical trial clearly provides superior accuracy in comparision to combined findings of CT and Bone scanning. All the best to you and all of us on our Prostate Cancer journey.

I sent a lengthy reply earlier, but for some reason it is not visible this morning. The short answer Gleason 4+3 =7=Grade 3 prostate cancer which is defined as unfavorable intermediate risk. That being said, putting the (3+3 core) aside, it appears that you have time to really do your research and learn all your treatment options, get multiple opinions if you can. Put your team together, your Urologist, Radiation Oncologist and a Medical Oncologist to help you with your decision and feel free to ask them Why and how does a test or therapy apply to your specific case. I put a general post for all on this thread earlier. I had an initial meeting with a Radiation Oncologist this week. I had 12 sample biopsy done by my Urologist with 2 cores comming back 4+3, one was 3+4 and one was 3+3, the others were negative. He is sending me for PSMA Pet Scan to assist with staging. He also told me about ArteraAI prostate test that he could send my biopsy slides off for testing. If the test comes back negative then he said, short term hormone therapy would not be recommended. That being said, speak to your Radiation oncologist about the trial that Dr. Scholtz speaks about and ask if your Rad oncologist is familiar with the Artera test and how these apply to your case of prostate cancer. Engage them in shared decision making. Lastly, hopefully they did more than just a bone scan for your imaging. If not, I would engage with your team as to why they did not do some form of CT or Tc88 scan with it and that you would like a PSMA PET scan done. If they don't have it there, then where can they send you to have it done. Regards to all of us on our prostate cancer journey

Thank you for the detailed explanation .

​@@maxstyle3286did you have an MRI ? What does the lesion look like? Is it pirads 4 or 5 ? Your slides can be sent for another pathology opinion like Johns Hopkins and it's not unheard of for it to be downgraded. You do not want to get your situation overtreated or undertreated. Genetics can also be performed on the tissue to help you decide.

Yes , I did have an MRI . PI-RADS 4 , 7X6 mm rounded T2 hypointense lesion in the right posterorectal peripheral zone . Having said all that , I understand that the study shows that for Gleason 7 do not really have to do hormone therapy . By Gleason 7 , i understand 4+3 and or 3+4 . Am i right ?

Thats a horrible situation to be in a nightmare, did u never get any psa's done before u where diagnosed, i hope everything works out for u

As mentioned above I just completed a regimen of Proton Beam Therapy and have had no rectal issues. I had to pee a bit more often at night with a bit of a “constricted” stream or flow, but that mostly went away after the first two weeks (used flo-max 💊then). I did have a “Space-OAR” before radiation which I highly recommend despite the short, Space-OAR procedure being painful. I did not find the previous biopsy painful at all, although it was a bit uncomfortable, but the Space-OAR (short procedure) was uncomfortable and painful, for me, but it was a quick procedure and again I recommend it to greatly reduce the chance of rectal complications from radiation

It sounds like you are asking about the employment of ADT in the salvage setting (post prostatectomy with PSA recurrence)? If that's the case, the use of ADT is controversial if the PSA is less than 0.2 when going on the table for RT, albeit the SPPORT trial would support it. I chose to decline ADT when I had salvage RT last year as my PSA was 0.146 prior to starting RT. It is now < 0.006 ng/mL one year out. So far so good, but not out of the woods yet for sure. But yes, in theory, if any cancerous cells remain and don't die when trying to replicate (which is how radiation works btw) then in theory you could have a recurrence. The theory of why ADT works is it "weakens" the cancer cells to make them more susceptible to the radiation, but this effect seems less pronounced when the PSA is low (i.e. less than 0.2 ng/mL). Again, everything I've written refers to the salvage cohort which is not the cohort in the study Dr. Scholz is discussing in this video.

Good point. Docs get a little hazy when they “explain” how ADT and radiation actually result in better results than radiation alone in the recurrence setting. Sometimes they seem to “explain” that the ADT helps to wipe out the cancer (kind of odd since the radiation alone kills what it hits nowadays) and other time they “explain” ADT is systemic and suppresses cancer throughout the body. But, as you point out, how useful is that if it comes back when the short course ADT is over? Also, in many cases the use of ADT confounds attempts to gauge if the radiation was effective -one has to wait until the ADT is halted and testosterone returns.