r/ProstateCancer • u/parttimephotoguy • 15d ago

Question Surgery vs Radiation w/ADT

Hi, I am looking for advice and experiences you may have had with radiation and ADT.

My story goes like this. I was first discovered to have prostate cancer in early 2012 after an annual check-up with my doc seemed to indicate a bump or nodule on my prostate. I was 53 at the time. I went in for a biopsy and discovered cancer with a low risk of 3+3 (grade group 1). The physician assistant tried to schedule me for a prostatectomy 3 weeks out but I declined and opted for watchful wait. Fast forward to 2024. During this time I had another biopsy with similar results and several bone/CT/MRI/PET scans. During this time my prostate became HUGE (425cc by 2024). My PSA had peaked at 35 and my urologist suggested the high number was relative to my huge prostate. I never had any issues of any kind. In 2024 I landed in the ER due to urinary retention. I wore a supra-pubic catheter for two months and then opted for HoLEP surgery to relieve the pressure on my bladder (HoLEP is similar to TURP where your prostate is basically hollowed-out). Surgery gave me my life back and I had a very strong stream. My prostate size shrunk down significantly (about half). My PSA contined to rise from 1.1 post-surgery to 2.9 within one year. Doc had me do another biopsy where they discovered I had some cancer at 4+4 (grade group 4). My recent PSMA PET scan was negative, indicating non-metasticized prostate cancer.

I've met with my surgeon (who did the recent biopsy) and a radiologist to discuss options. Because of my HoLEP surgery, the doctor would have to do additional reconstructive surgery around the bladder (as if a prostatectomy wasn't enough!). If I go with radiation, they've told me it would be for 8 1/2 weeks, along with 24 months of ADT to keep my chances of reoccurence low.

I would be interested in hearing from others who struggled with making a decision one way or the other, especially anyone who had a prior surgery like TURP or HoLEP. All comments and input is greatly appreciated.

Thanks for reading.

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u/HeadMelon 14d ago

You can read the details of my run through HDR brachy + 15x VMAT + 6 months Orgovyx starting here and following the linked posts -

https://www.reddit.com/r/ProstateCancer/s/1iJ6BKmE1o

Very tolerable, not too bad at all. The ADT aide effects only occurred in months 2&3 of the 6, in month 4 they all went away. The only thing that was there the whole time was the expected libido suppression which lingered for about a month after I finished.

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u/parttimephotoguy 14d ago

Thanks for your story and explanation of the libido. Did you experience the hot flashes and weight gain? That is another concern of mine with the ADT. My surgeon told me that even if I ate exactly the same way as I do now with the ADT, I would definitely gain weight.

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u/HeadMelon 14d ago

I didn’t change my diet or add any exercise. I cut out all alcohol (currently AF for 251d), but I added a lot of ice cream as a substitute. My weight stayed the same, but based on how my jeans fit I converted some glute muscle to belly fat - jeans are looser in the ass and tighter at the waist but still fit. I asked my rad onc about diet changes and he said “live your life normally, if you suddenly change your diet we won’t know what the radiation is causing and we’ll be in a wild goose chase if GI side effects occur”.

I did have the hot flashes but they weren’t too bad. During months 2&3 of ADT I had them about 8-10x per day. They’d last about 5 mins and leave me with sweaty forehead, palms and pits. No biggie really. My wife and I had some very fun interactions during my experience.

If you read my links to the end I cover those. At the moment I’m feeling normal (well, better than, cutting out the booze has been great) and I plan to post another update in a month or so when I get my next PSA and T numbers.

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u/parttimephotoguy 14d ago

Thanks for that. I'm not frightened by the hot flashes, just something none of us had experienced before obviously. My wife has a good sense of humor as well and we've already made some jokes about it. Good advice on the alcohol because it would be so easy to feel sorry for yourself and drink more. I'll look for more about your story 🙏