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Importance of ADT with SRT -- please help

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Prostate Cancer
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MotownPaul
Regular Member
Joined : Aug 2018
Posts : 151
Posted 11/1/2018 7:50 AM (GMT -8)
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.
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Cary1963
Regular Member
Joined : Aug 2016
Posts : 33
Posted 11/1/2018 9:00 AM (GMT -8)
I had similar concerns as you, and chose 1 month ADT shots so I could discontinue treatment if the side affects were not tolerable. You should also consider the time it takes for your PSA to recover after ADT.
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InTheShop
Elite Member
Joined : Jan 2012
Posts : 11468
Posted 11/1/2018 1:21 PM (GMT -8)
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.
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P34
Regular Member
Joined : Jun 2018
Posts : 110
Posted 11/1/2018 1:35 PM (GMT -8)
I had the same concerns. I've dealt with depression for years too. I did feel some increased depression but for me, knowing it is "chemically" induced and temporary seems to help. It does make me feel weepy a lot though. This is just my experience. I had the 6 month shot.
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F8
Veteran Member
Joined : Feb 2010
Posts : 5714
Posted 11/1/2018 1:39 PM (GMT -8)
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.
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Pratoman
Forum Moderator
Joined : Nov 2012
Posts : 9320
Posted 11/1/2018 2:11 PM (GMT -8)
My understanding is that ADT confers significant benefit with higher Gleason scores.
I’m not sure that depression will get worse with a 6 month course. It might. But I don’t think it’s a given.
If I were in your shoes, I’d consider 1 month shots, and start with an understanding that if it gets too hard, you can discontinue the shots. But I’m not in your shoes, only you can decide what’s right, for you.

I am however, in my 3rd month of ADT, and so far, only mild hot flashes, no other side effects. But everyone is different
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GoBucks
Veteran Member
Joined : Jan 2018
Posts : 1247
Posted 11/1/2018 5:47 PM (GMT -8)
I agree with Prato. Another thought, perhaps your current meds will ameliorate any bad side effects.
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trailguy
Veteran Member
Joined : Jul 2015
Posts : 872
Posted 11/2/2018 3:52 AM (GMT -8)
Lack of testosterone weakens the cancer cells, prevents their moving around and reproducing and stops cancer cells from advancing in state (like G4 to G5). It is believed that while so weakened, the radiation treatments are more effective in killing the cancer cells.

I deal with my inclination to depression by maintaining a rigid (somewhat extreme) daily exercise regimen as part of a seriously structured daily task schedule. I carry a lot of constant pain. Getting in a daily 7 mile run dumps sufficient quantities of endorphins into my blood stream to dull my perception of that pain and to prevent my mood from going foul or depressive. Discovering this many years ago has saved my life, for sure.

My Lovely Lady Labrador enjoys it as well. wink
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Skypilot56
Veteran Member
Joined : Mar 2017
Posts : 1452
Posted 11/2/2018 4:28 AM (GMT -8)
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
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Brook58
Regular Member
Joined : Sep 2017
Posts : 52
Posted 11/2/2018 7:29 AM (GMT -8)
Ok, I'll be the first one to say go without ADT. Save it for later.
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lifeguyd
Veteran Member
Joined : Jul 2006
Posts : 691
Posted 11/2/2018 7:46 AM (GMT -8)
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.
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mattam
Veteran Member
Joined : Aug 2015
Posts : 3991
Posted 11/2/2018 8:36 AM (GMT -8)
Paul,
I empathize with the decision process you have right now. I have struggled with major depression my entire life. I had RT very soon after RP and it was decided not to do ADT in my case. My primary concern was to protect my mental health. It turned out to be a moot point because in retrospect I was clearly already systemic prior to my treatments. I will be going on lifelong ADT soon and its possible effects on depression continue to be a big concern to me. Because of the strong depression remission I have from my medications I am confident that my mental health will hold up well with ADT.

I don’t have solid advice for you. It’s a difficult decision. Sorry I couldn’t be more helpful.
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