SBRT with ADT or no ADT

Heff

Hello, I have been diagnosed with localized prostate cancer this past summer . PSA 7.2 Gleason 3+4 .decipher 0.49 My Father died of Prostate cancer 2007 at 72 . I am 66 . I have decided on SBRT rather than Radical Prostatectomy . The oncologist suggested ADT ( Androgen Deprevity Treatmant ) or I can decline at this time . Looking forward to hearing from those who have had experience with this . I really do not want to go through the hormone therapy .
Thank you . Heff

capecodder

Heff- I am almost your clone in terms of PCa situation. 66 yo, father with PCa, diagnosed last Dec with 3+3, low PSA of 2.0, history of BPH that has been treated well with Cardura and Gemtesa (helps with overactive bladder) so I only pee 1-2x per night. Upgraded to 3+4 (10% of one core had 4) in late August from confirmatory biopsy at Dana Farber in Boston. Learned I also carry CHEK2 gene this summer, and just got DECIPHER score of 0.54 in mid-November. Doc feels I should start some treatment in next few months. Was leaning towards surgery as I am otherwise is good health and think I would recover well, understanding the potential of incontinence and ED for a while (possibly long while). I just want the cancer out and like having the option of radiation if there is recurrence after surgery. However, I spoke with a radiology oncologist from Dana Farber this morning, and he gave me more confidence in SBRT. He said he does not think I would need ADT at this point. I am also worried about possibility of other cancers from radiation, like bladder or rectal cancer, but he said chances are < 0.5%.

Interested in your thought process to choose radiation over surgery. I will also read the responses you receive from others since we are in similar situations.
Thanks.

swl1956

I'm fairly certain ADT will significantly improve your odds for a better outcome when added to radiotherapy of any type. I've been on relugolix and abiraterone + prednisone for about a year now. Prior to treatment my PSA had reached 9.3 with a 4+3 Gleason score. I was started on ADT a couple months prior to my 40 IMRT treatments. Once determined that metastasis to pelvic lymph nodes had occured it was a no brainer for ADT which I'm supposed to continue for a total of 2 years. The ADT in my case hasn't been all that bad so far. The occasional hot flashes are annoying but very tolerable. Fatigue and dry skin are my biggest complaints. In your case with a family history of Pca, I think you should seriously consider ADT. The SBRT should be very easy to tolerate with perhaps only 5 sessions. Talk to your doctor about perhaps a shorter coarse of maybe 6 or 12 months of ADT. My PSA for the last nine months has been in the undetectable range. 😀 My journey started out as a medium risk of metastasis. I had all the tests. MRIs, two biopsies, bone scan, genetic test, PSMA PET scan, all of which concluded the cancer was contained in the prostate gland. I chose a Focal therapy which I was told I was a good candidate for yet 6 months later Pca had metastasized to pelvic lymph nodes. If I could go back in time, I would have insisted on ADT right from the very beginning. In most men it's very effective at halting spread and reducing tumors.

Clevelandguy

Hi,

A lot of doctors want you to take ADT before your radiation to weaken the cancer as a standard method. As a lot of people can attest to, depending on the type of ADT drug it can be rough on you. Mood swings, hot flashes,weakness due to muscle mass loss, ect. From what I have heard there are some newer ADT medications that lessen some of the side effects and even daily pills instead of injections. Surgery is a good alternative to radiation with different side effects. Capecodder is spot on with his analysis. I had surgery 11 yrs ago and don’t regret it knowing I have several good backups if my cancer returns, ie; radiation,Proton radiation, maybe ADT(I said maybe). Always have a future plan before you make your decision. Surgery after radiation is usually a little more tricky because the radiation has shrunk you Prostate . If you choose radiation check into putting a gel between your Prostate and Rectum to protect your Rectum from radiation damage. If you choose surgery there is a new one entry point robotic surgery that preserves nerve function better than my 5 port procedure I had 11 yrs ago. Get the best doctors + facilities to get the best results. Its your body that will live through your decision so study and you will come to the right conclusion for you. Good luck. I have included a link for you to study.

https://www.cancer.org/cancer/types/prostate-cancer/treating.html

Dave 3+4

swl1956

Heff,

These videos might be helpful if you haven't seen them already.

https://youtu.be/ryR6ieRoVFg

https://www.youtube.com/watch?v=cyY0nHXvzGc

swl1956

Keep in mind ADT affects men differently. Some have very little side effects and others struggle with it. Dr. Scholz points out that you can always discontinue it if it's too much of a burden.

Wheel

i am 100 percent behind the single port robotic surgery. Also the surgery procedure position that spares the Puboprostatic ligament normally cut in most procedures. With it not being cut this keeps your penis length and in most cases eliminate’s incontinence. I was dry immediately. In addition the nerve sparing, and Retzius sparing keeps ED to a minimum not certainly guaranteed but in my case worked. I just need to take Viagra and good to go. Went home same day of procedure. 3 days after catheter out traveled by car for four hours, on plane a month later internationally. I had procedure last year, am 72. Still have Radiation available in future. No months long Radiation treatments or ADT for long time. I believe certainly Radiation Oncologist’s believe in their work as Surgical Oncologist’s also do so just make sure you research both and get the best. I am glad it was over in four weeks recovery and feel like my gallbladder got removed.

Steve1961

here is my opinion ADT is the third option is the last option. It’s a horrible option. It literally destroys a man. I don’t care what anybody says look up the gold standard for prostrate cancer if it is localized and you expect to live 10 years or more Gold standard is surgery then you have radiation as a backup and then you also have the dreaded ADT as last choice Also, you need to make sure cancer is not Cribbiform I was diagnosed at age 56. My PSA was about the same. It was 3+4 and I was scared to death of surgery. The decifor testing said that I had cribbiform So I chose the radiation route which was a huge mistake huge for one it tore me up And for two it did not work five years later my PSA went down to 0.8 and started climbing only to find out that the for cancer was still inside me. It did not take to the radiation. Let nobody tell you any Different cribbiform is radiation resistant so my friend choice is yours. You’re only 66 to me the surgery was a piece of cake. I wish I would’ve the first time around even salvage surgery wasn’t that bad except I do leak a little bit But now I can’t have radiation again so if it happens to come back, all I can do is a dreaded hormone a simple process step one surgery. It’s done it’s gone. It’s out of your body if your psa is not undetectable you could do radiation to kill the rest of . Keep the radiation as a backup and the ADT as a third backup but if you’re gonna go that route the radiator you must and you must make sure it is not crib form that’s just my opinion. Good luck to you.

Old Salt

Whereas the effects of ADT are not pleasant by any means, it's not the end of the world either. As has been pointed out, effects vary a lot on a person-to-person basis.

More in general, forums such as this one depend to large extent on personal experiences. I strongly suggest to consult the medical literature for relevant studies. These days, AI is a good source as well and makes it much easier. In this context, I asked Copilot if ADT would improve outcomes for prostate cancer patients with confined Gleason 3+4 disease.

For patients with Gleason 3+4 (Grade Group 2) and PSA <10 ng/ml, radiation therapy alone provides excellent outcomes. The addition of short‑term androgen deprivation therapy (ADT) offers only modest benefit in this favorable intermediate‑risk group, and many guidelines recommend radiation alone unless other risk factors are present.

Pretty strong consensus statement, IMHO.

PS: Studies have shown that SBRT is a good choice for this particular case. Just make sure it gets executed by knowledgeable staff with lots of experience.

Clevelandguy

Hi,

For information on Prostate cancer, places like Sloan Kettering,MD Anderson,Mayo Clinic and Cleveland Clinic all have very active Pca programs and are a good source for info. AI depending on who set up the algorithm can be a little off the mark sometimes from what I have learned by looking into various topics.

Dave 3+4

billray

I have pushed so much to the back of my memory, I have forgotten the terms, etc. and for that I apologize. Tis could be caused by the Lupron, not certain. I was diagnosed at 65, in 2023, with PCa, T2c. I have 2 PNI. My biopsies revealed 4+3s in 7 of 12, couple 3s. I was placed in the intermediate/low-high range for progression. I did not chose surgery. Using my research and discussion with my Urologist and Oncologist, as well as the Primary, I determined that Cyber Knife was my choice. 5 intense treatments. Prostate intact, but highly radiated… and then I think it is referred to as ADT… Lupron, scheduled for 18 mos. I chose not to go monthly, but to receive the shots high dose, every 6 mos. My first six months became horrendous. Every side effect listed for Lupron came to visit. Muscle cramps, muscle loss, breast development (I noticed), hot flashes, exhaustion, nausea, memory loss…. it stole my testosterone. I refused the treatments for the following 12 months. I wanted quality of life, not a nap every afternoon for 3 hours. It took months for my body to recover from the Lupron, meaning to feel good again. Then in early summer 2025- I began free bleeding through the rectum into my clothing without being aware. A most humiliating and embarrassing event to have happen. After a few months and a few doctor visits, I discovered the radiation had over 18-24 months-which is not unusual- destroyed three of my larger vessels in the rectum. I had the surgery to repair those three in late November '26. Stitches erupted within days because of weakened muscle walls, swelling took place, I could no longer pee, first catheter placed in on Tuesday before Thxgvining and by end of week, even the interior of my bladder was so weakened that I was bleeding into the cath bag. Admitted into hospital for 7 days, bled for three days and nights before it stopped, bladder being constantly flushed to remove clots. This was just last month, a few weeks ago. I am healing, the rectal surgery is no longer bleeding, still feel pretty bruised. I am now concerned if it was radiation damage to the bladder or a poorly installed catheter that caused me to bleed so… research says the radiation damage will continue to destroy the healthy tissues of the rectum for sure. So I find myself wondering how long before the next big event. I have no real question, I just wanted to share in a space where guys know it isn't just the immediate time of treatments, but PCa treatment side effects occur a couple years later, as mine did. But I have this. Feeling stronger every day… and my last PSA in OCT was below 1 after 2 yrs. So that is good. "Keep it low, good to go"…. right. Except when I was diagnosed, my PSA with the Intermediate/low-high stage was really low for being my age… it was only 4.1. that's considered Normal.

Old Salt

Wow; that's a really shocking story, billray.

Where did you have the radiation (SBRT/Cyberknife) done. It almost seems like it wasn't properly targeted. I do hope you are well on your way to complete healing.

VascodaGama

@billray

Thanks for sharing your story.

Not all members who have chosen RT as their prime intervention experienced those nasty circumstances, but several survivors in this forum have reported being affected with RT side effects at different later stages.

Unfortunatly, I  am one of them, 19 years post SRT (IMRT) in 2006.

5 months ago I finished a period of hyperbaric treatment that managed to cure radical cystitis in the bladder.

Surprisingly, the urologist is of the opinion that these effects could  be behind the present hyperactivity status of my bladder that set me with uncontrollable incontinence. It all started at the begining of 2025 after a TURBT.

The urologist wants me to have more sessions of hyperbaric aiming to a better functioning of the bladder (?).

Well, we never know what to expect. Hopefully it all keeps well for you.

Best wishes in your journey.

VG

billray

Thx for sharing your story. I hope your treatments help. I think its important that men know there are those of us who do have intense radiation damage, mine w/in that 18-24 mos period following, yours a few yrs later. It’s also important for everyone to understand your PSA can be in the normal range and you can still have an ugly cancer. If I had not followed my “gut feelings “, even changing Primary Dr, i would be in a worse health crisis than I am emerging from.