Would combined SBRT & ADT result better than SBRT alone?

I just saw a RO and we discussed radiation options based on my situation (see signature). The doctor recommended that I do combined SBRT & ADT in parallel, following this plan: 3-month ADT, then SBRT, and another 3-month ADT.
The benefits of using ADT, according to the RO, are: 1). it can kill the microscopic cancer cells outside the prostate if any and thus decrease the risks of metastasis; 2). It weakens the cancer cells in the prostate to help SBRT to kill them more effectively.

Based on my situation, do you think I need SBRT with ADT or SBRT alone would do the same job.
Your input would be greatly appreciated. Thank you!

not an expert on this, but in your place I'd be thinking of doing both.

Andrew

My doctor gave me the option of SBRT with or without ADT. He felt that adding ADT would increase efficacy of the treatment from 80% to 85%. I choose the nine months of Lupron.

The evidence so far is that ADT is not necessary when used with extreme hypofractionated radiation like SBRT and HDR brachytherapy. There have been no randomized clinical trials yet.

Alan Katz (see link) included in his study 51 patients who received up to 6 months of ADT with their SBRT and found "Our data also show no significant benefit for use of of ADT."
/www.ncbi.nlm.nih.gov/pmc/articles/PMC4150980/

Jeff Demanes found there was no benefit to adding ADT for any risk group when using HDR brachy combined with external beam radiation:

Excellent Results From High Dose Rate Brachytherapy and External Beam for Prostate Cancer are Not Improved by Androgen Deprivation

Lack of benefit from a short course of androgen deprivation for unfavorable prostate cancer patients treated with an accelerated hypofractionated regime

The lack of benefit for intermediate risk patients (but not for high risk patients) was observed in this German study:

/www.ncbi.nlm.nih.gov/pubmed/25471276

Demanes gets excellent outcomes in intermediate risk patients with HDR brachy monotherapy without adding the toxicity of ADT. This was true for unfavorable intermediate risk patients as well:

High-dose-rate brachytherapy monotherapy without androgen deprivation therapy for intermediate-risk prostate cancer

I'm afraid that you'll just have to choose which way you want to go. Recent clinical experience and research tend to suggest that the hormones can be avoided with SBRT but such experience is not universal and the science is more suggestive than compelling at this point. There's also the idea that hormones might help with high-risk cases but not low-risk. But again that leaves you teetering on the edge -- with your single Gleason 7(4+3) biopsy core you are in the unfavorable half of the intermediate-risk category but with only a single core you're probably not at the top.

But, one thing you should bear in mind is that most of the guys on the forum who complain and complain about the side effects of their hormone therapy -- and I made a poor secret of hating mine -- have been on the loathsome stuff longer than your RO proposes that you put up with it. Six months is easy time and being a young, healthy guy you should expect to recover quickly when the androgen blockade is lifted.