SRT without ADT?

I do not know if you read studies, but this one recommends two years of ADT in your situation:
Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer

You may get away with 18 months too.

George

When I was deciding to have ART or not, which was an incredibly hard decision, I got three opinions, 1 from my URO/Surgeon, and 2 from RO. Both ROs thought it wasn't necessary with my pathology for HT, my URO recommended 6 months Lupron. I read all the studies which showed the benefits of HT with SRT, saw other that said not necessary for Gleason 6 or 7. Ultimately decided not get the HT. I hope to avoid HT all together and take a chance I haven't micro metastasized, and the radiation killed the remaining cancer cells. Educate yourself, gather as much info as you can,weigh the risks and rewards, and make a decision you feel comfortable with.

George,

Interesting study. The only negative thing about it is that it is 15-20 years old. Newer studies do not differ much on the results in their assessment of SRT with HT or without. Something in the neighbourhood of a 4-6% more positive survivourability with HT. Just wonder if the advances in SRT technology in the last 20 years have made HT with SRT less important for survival for intermediate PC as opposed to just SRT especially if they also target the lymph nodes that are in the prostate area, something that was not done in the study that you quoted.

Dave

Michael_T said...
I was surprised at the degree of benefit from ADT when Pratoman was going through his SRT decision. I don't want to speak for him, but I recall it was significant.

Given the involvement of lymph nodes and a PSA of >1, it seems to me that you'd want to be throwing everything at it, but it also seems like your RO is okay with you forgoing it.

For clarity, the MSKCC nomograms showed, in my case a 15-20% advantage. My RO said in my specific situation, he thought it would give me more like a 5-10% advantage.
I wanted every advantage possible.

Slapshot,
If I understand your signature correctly you had a positive lymph node at the time of surgery. Now your scan shows two more suspect lymph nodes. That being the case, if it were me I'd definitely agree to the ADT and also to SRT targeting lymph nodes to the extent it can do so safely.
Jim

Independent of my post above Slapshot, if I had your pathology I would 100% opt for ADT, even as I am convinced that many who think they "are throwing the refrigerator at it", really need to do more research.

Good luck, whatever you decide.

George,

Looks like a lot of info to digest. Thanks for the effort in researching these studies. I was hopeing to defer HT until the future as I have a big cross country ski competition in Norway, March/19 and I believe being on HT for the next 6 months would not be beneficial to my training. Having read so many accounts of those who have taken HT and the SE, as I wrote a while back, I would rather make a deal with the devil than take HT. But I guess you can have short term pain, for long term gain.

Dave

Dave, awesome photos on your blog site. I can see why you would want to avoid HT, with the active lifestyle you lead.
Still, the goal is to be able to live that lifestyle for many more years, as I’m sure you’ll agree.

Good luck.

Dave,

I did not post all these studies to tell you you can do the ADT some time later when you feel like it. Its not that simple. If you decide for ADT, you will want it to work in synergy with the radiation.

On the other hand, the radiation can cause side effects that will stop you to take part in the competition - with and without ADT. So doing RT after the competition can make sense.

George

I regret not doing ADT. now I am stuck wondering when I should start my
Lifelong ADT. Too late for me now.

Slapshot,
I'm not a competitive athlete. I suspect ADT will probably hurt your performance time. But I am very physically active and have had minimal side effects from ADT so far. I'm in my fifth month on Firmagon and have had no hot flashes or fatigue.

I had to suspend my daily workouts on a combination rowing machine / recumbent bicycle for several months due to a kidney stent needed for a blockage caused by an enlarged lymph node pressing on the ureter. (BTW - that's one more reason to not let those lymph nodes go without ADT). The Firmagon shrank the lymph node in no time but it took another two months to get an appointment to have the stent removed. Having now resumed workouts the Firmagon doesn't seem to have affected my performance. My normal workout is about 40 minutes of rowing followed immediately by 20 minutes of peddling (with the machine set for higher resistance when peddling). Other than reducing the resistance for rowing for the first week or so, my performance is pretty much where I left off. I end the hour workout with my pulse at 120 and the machine showing I've burned about 700 calories. I don't know if the calorie measurement reflects actual calories but it offers a constant for measuring performance.

I perform maintenance and oversee volunteer work on a parcel of town-owned conservation land - 62 acres of fields, forest, and wetland plus a 30 acre pond. Throughout this summer, even with the stent, I've done my normal work there a couple of days per week for a few hours at a time. Work entails mowing trails and clearing field edges with a 350 pound walk-behind brush cutter, fighting back invasive growth, cutting and clearing fallen branches, etc. The brush cutter has forward and reverse but has to be wrestled through turns - kind of like trying to turn a snow blower with the hubs locked. I also use a 20 pound heavy-duty brush saw / weed whacker carried on a should harness with a hip mount for the brush saw, and occasionally use a chainsaw. I have no way to measure directly but I consider two hours of trail and brush work the equal of a one hour workout on my home exercise machine in normal weather and probably more on a hot day with a high dew point.
Jim

Post Edited (Bohemond) : 9/3/2018 4:26:38 PM (GMT-6)

Behemond, I would like to echo what AK said. It was a pleasure fir me to read your experience with ADT. I hope it helps the original poster as well.

I had my first Firmagon 12 days ago and so far no side effects to speak of, other than a reaction to the shot, which only lasted 2 days. I know it’s too early for me to draw conclusions. But your post gives me hope.

My wife is a very wise woman. I was really upset at the prospect of becoming. “Different person”. She saw that on the day of my first shot on the way to the hospital. She pointed out to me, that in this case, positive thinking really does matter. And that if I expected it to be a mess, it probably would be, fullfiling it’s own prophecy. Maybe she’s right (again)

She probably is, she likes to tell me “I thought I was wrong once, but I was wrong”