Will soon start hormone therapy, then radiation

I started ADT with Goserelin 10.8 (three monthly administration) in August. There has been a very satisfactory PSA response and an improvement in mpMRI status after three months. I have had a planning session for IGRT that will start next week and consist of about 20 sessions.


I understand “standard of care” can be 2 to 3 years with ADT, though I have read some papers that suggest 18 months could be adopted as “standard of care”. So far, for me the after effects of ADT are not incapacitating, though a bit of fatigue, an occasional downward plunge in mood and loss of libido are things one could have done without. However, if one thinks in terms of the number of shots left for ADT (4 more for me, if 18 months is the duration), then ADT takes on a manageable perspective. There would be tests to monitor the status and those too can be treated as part of one’s routine.


As for radiotherapy, from what I understand, it takes about 40 minutes for a session, the actual radiation time lasting about five minutes or less. In your case, since the planning is for 9 weeks, the timings may be a little different. The chief concern amongst patients in respect of Radiotherapy are the side effects. Many different doctors I have met do point out the possibility of side-effects but some also mention that all the side effects need not necessarily affect all patients. I am keeping my fingers crossed. Ultimately one has to put one’s faith in the specialists administering treatment.


In your case, in spite of the 4+5 Gleason Score, since the cancer is confined to the Prostate, did you seek an opinion on focal treatment like HIFU, TULSA or Nanoknife?


Whatever you choose, you should know there are a number of tried and tested measures to guide the course of ADT+RT and you should have a sense of determination to knock out the carcinoma that has caused you this bit of problem. I wish you luck and a successful outcome.

Hi . Your concerns about the androgen deprivation therapy (ADT) are certainly understandable. Unfortunately, pretty much all of the research I located points to ADT with a Gleason 9 leading to better outcomes (see this research article which concludes "ADT should be a component of treatment for most men with unfavorable intermediate- and high-risk prostate cancer receiving curative dose radiotherapy:" https://www.frontiersin.org/articles/10.3389/fruro.2022.890814/full). One thought is to speak with your doctor about the new pill form of ADT, Relugolix, which, while it has many of the side effects, has been found more effective, with a better safety profile (see: https://www.nejm.org/doi/full/10.1056/NEJMoa2004325).
Concerning focal therapies, such as mentioned by , they have made significant advances, but concerns for their use on high-risk prostate cancer remain. This article gives a good overview of research on focal therapies: https://www.hematologyandoncology.net/archives/february-2020/focal-therapy-for-prostate-cancer-recent-advances-and-future-directions/. I will note, as does this article, that little research exists about utilizing ADT with focal therapies. Your doctor should be able to provide additional information on this front if you are interested. Wishing you best and please feel free to keep us posted on how you are doing. Richard (ProstateCancer.net Team)

My situation was very similar to yours -- specifically a fully contained Gleason9. Given the aggressiveness of the cancer I met with both urologists and radiation oncologists and decided on surgery as my line of defense in case the cancer retuned. The surgery was successful and all of my pathology reports showed no sign of spread. I regained sexual function in 2 months and was totally dry by 5 months.


Given there are millions of cancer cells it was not surprised when my post PSA score started to rise to 0.13. I was then treated with Lupron and radiation for 8 weeks. I am now 5 years past the last treatment and so far its NED. My ADT treatment was a 6 month LUPRON shot and the side effects (hot flashes mood swings etc) for me lasted 14 months.


The trouble with all of this is ... we are all different so various best approaches are best left to the medical professionals. Always get a few medical opinions and then do what feels right to you. Once you do there is no sense looking back ... just move on living life to the fullest. Dennis (ProstateCancer.net TEAM)

Thank you, Dennis. I've read about your journey, and I plan to watch your videos. You provide very helpful information, and it's much appreciated.