Is androgen deprivation therapy (ADT) always necessary when prostate cancer patients undergo radiation? And if so, for how long—six months, a year, two years? In this insightful conversation, Dr. Geo sits down with Dr. Nima Aghdam, radiation oncologist at NY CyberKnife and NYU Langone, to explore the evolving role of ADT in prostate cancer treatment.

Dr. Aghdam shares his expertise on advanced radiation techniques like SBRT, personalized approaches to ADT duration, and the importance of lifestyle interventions. Together, they highlight how individualized care can improve survival, minimize side effects, and help men thrive beyond diagnosis.

If you or a loved one are facing decisions about radiation and hormone therapy for prostate cancer, this episode offers clarity, evidence-based guidance, and hope.

Radiation vs. Surgery: Both are highly effective; choice often comes down to quality-of-life goals and patient preference.

Lymph Node Positive Disease: Options include focal SBRT or comprehensive external beam therapy; treatment decisions must balance efficacy and quality of life.

Lifestyle’s Role: Exercise and nutrition create a “hostile microenvironment” for cancer, improving both survival and side-effect management.

Radiation Innovations: From rectal spacers to fewer treatment sessions (trials reducing SBRT from five to two fractions), techniques continue to evolve.

ADT Considerations:

Historically prescribed for up to 24–36 months with radiation.

New genomic and AI-based classifiers may allow some men to stop ADT earlier (6–12 months).

Balancing survival benefits with quality of life is critical.

PSA Anxiety: PSA fluctuations don’t always equate to recurrence or mortality. Context and long-term monitoring matter more than isolated numbers.

Finding the Right Oncologist: Beyond equipment and technology, trust and honest communication with your doctor are essential.

Timestamps

00:00 – Introduction: Is ADT always necessary during radiation?
05:00 – Radiation vs. surgery for localized and advanced prostate cancer.
10:00 – Salvage options: what happens if radiation or surgery fails?
13:00 – Treating prostate cancer with lymph node involvement.
17:00 – Communicating metastasis risk and long-term outcomes to patients.
18:30 – Lifestyle interventions as part of prostate cancer care.
21:00 – Rectal spacers and preparation for SBRT.
23:30 – Advances in SBRT: reducing from five fractions to two.
25:30 – Understanding fractions, dosage, and radiation delivery.
32:00 – Personalizing ADT: who benefits, and for how long?
36:00 – Clinical trials on ADT duration (6, 12, 18, 24+ months).
39:00 – Radiation’s long-lasting effects and how ADT fits in.
42:00 – PSA recurrence vs. actual risk of mortality
45:00 – Patient anxiety and the psychological impact of PSA testing.
47:00 – Exercise and lifestyle: evidence for improved survival.
49:00 – Supplements, PSA manipulation, and misinformation.
51:00 – How to choose a reputable radiation oncologist.
56:00 – Evolving evidence: are radiation-related risks lower today?
58:00 – Parting words: seeing prostate cancer as a chance for transformation.

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⚠️ Disclaimer

This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

Speak Better English with Harry | Episode 555

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