Importance of ADT with SRT -- please help

Hello all,

I am at a critical juncture and need your help. To summarize my signature below, I am a Gleason 8 and had RALP last April. I showed BCR three months later with a .20 and it now stands at .33. A recent Axumin scan showed nothing.

I have consulted with ROs at two major and highly-ranked cancer centers and have been offered two different treatment paths. The major difference centers around whether or not to include ADT for six months with my 40 radiation treatments. Both doctors understand that the standard of care is to include ADT; however, I suffer from major depression, anxiety, and PTSD and take many medications for those conditions. My wife and I shared with both ROs our concerns that the ADT might possibly put me into a deeper depression / anxiety and negatively impact my treatment path. One RO (who I've been seeing for 3 months) told us that he would be comfortable forgoing the ADT and cited studies that would indicate that doing so would have little if any impact on my chance of a cure, when considering all aspects of my case. He cited the fact that my PSA is still relatively low (.32) and that it has not moved up in two months, indicating that it is not acting aggressive at this point. He seems hopeful that the cancer has not moved beyond the prostate bed or nearby lymph nodes but acknowledged, of course, that there is no way of knowing for sure. The other RO we consulted with on Monday (our only visit) cited a new study that showed a considerable benefit to using ADT and therefore recommended that in her treatment recommendation.
Both ROs are highly qualified and I like and respect them both, so I am really struggling with which way to go: ADT or no ADT? They both agree that treatment needs to start very soon, so I need to give this careful yet immediate attention.

Questions: Are my ADT fears unfounded or misplaced? Does ADT have a real impact on outcome, or is that debatable? What would you do if you were me, based on your research, experience, and what I have outlined here?

Thank you in advance for your input.

it's important for those with higher risks. It helps maximize the effect of SRT.

ADT's side effects differ from man to man. Some get hit hard and others not so much, but yes it's likely to make depression worse. Likely you'll want to watch that very close and might need extra help there.

no one wants to be chemically castrated but you'll get through it. if I were at .33 i'd want a shot yesterday of the fastest acting stuff which I believe is firmagon. good luck man.

I agree with Prato. Another thought, perhaps your current meds will ameliorate any bad side effects.

Motown Paul.. I would suggest that you read through the ADT and SRT Journey thread. It's 5 pages long but there are some great experiences there that the guys have gone thru! If I was in your shoes I would be getting the shot next week your jumping up pretty fast and you want to try and stop the cancer in it's tracks! This is just from my own experience yes the SE's of Lupron are not fun but sure the frick a lot better than the side effects of advanced PCA.
Wishing you the best in whatever you choose and be sure to let us know how things are going

There is no doubt that ADT increases the risk of depression, deep vein thrombosis and can increase kidney failure.
That is among the reasons we chose to defer using it as treatment. However if your psa continues to climb, you should consider it. That is where I stand today.