I have a question about the effectiveness of ADT in
Terms of the length of time before it becomes resistance.
I have heard a doctor that says one of his patients were on
It for 17 years, I have read on other sites that some patients
Lasted 18 years on it. Some patients with similar stats like mine
Said pc is not life threatening for at least 15 years from now and
On the other side, I have heard a lot that adt lasts 2-3 years before
Resistance and then you go on another adt that might last for less time
If I can have a realistic answer to this, I would relax a bit and try to
Go on with my life instead of going crazy trying to find an answer to
This question
My stats are : RP(12/2012), IMRT(1/2017), 3+4, t2c, current psa .36 with DT of 5.5 months, no detected Mets at this point , not on any meds and debating what to do next
Thank you all
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StayingOptimistic
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PSA up 10 points in 6 weeks after RP. Started ADT drugs. Tests showed Gleason 9 in all neural and veinous channels out of prostate area and even in unrelated tissue samples. Told ADT forever as I have fast growing, invasive, aggressive, metastasized and incurable cancer. No way ADT for life. Orchiectomy and no more testosterone to block and no ADT drugs. Drastic, but at 68 with jelly bean sized gonads from ADT and steroids, not a real loss. Chemo, xtandi, orchiectomy and PSA floating at 0.140 area.
I was worried about the same topic last week. My Oncologist showed me a chart of a patient that has been on the therapy for 20 years and still going.
You can go very far on the therapy.
I read somewhere that guys with local treatment, no mets, low PSA, long doubling time have the best chance of going a long time on primary ADT. Guys like me who are diagnosed with stage 4, lots of mets, high PSA etc. tend to get the least time out of it (generally around 18 months). I got about one year.
But of course these are just statistics and it's best to live your life without them. You need treatments, but you can live without statistics and also have a better quality of life.
My husband, Les, was diagnosed in the fall of 2004, stage 4, Gleason 9 or 10, psa 16.9, cancer in the neck of the bladder, outside of margins and in his tailbone. He just got his 6 month Lupron shot a few weeks ago. His ultra sensitive psa test was less than 0.01. No other medication except Lupron. He leads a normal life of a guy almost 70. Keep the faith and aloha.
There are statistics but remember, the average includes people at both ends of the bell curve. Alas, I was at the wrong end of the curve and ADT became ineffective after 3 months. My PSA was 7.5 in May 2017 when I started Zolodex and 2.5 in Aug 2017 (nadir). PSA was 21 in Nov 2017 and MO added cosodex to the mix and PSA jumped to 47 by Christmas 2017. Chemo has subsequently helped slow things down.
I was psa 7.8 and Gleason 7 on diagnosis in 2015. After RP it was discovered that there was 1 positive lymph node (out of 20 removed) but no distant mets. PSA 6 weeks after surgery was 0.026 and there was certainly no hint of the dramatic rise to follow.
I dont want to scare you but you asked the question. I really do hope that ADT works for you for 18 years but be aware that outcomes are highly variable. There is no 'realistic' answer. It really is suck and see.
Started Intermittent Lupron 2007--went continuous 2015 with casodex--added zitiga oct/17 psa <0.1 testosterone ,<0.1--f except for fatigue feel very lucky. Lympth node in pelvis since 2007.
I’m with Gregg57. Length of time ADT will work is highly unpredictable, and statistics on it are unreliable. Addition of early chemo with docetaxel has been shown to extend the time, sometimes significantly, that the ADT drugs will work. I’ve been on Lupron and Bicalutamide for 3+ years. Had 6 cycles at 3 week intervals of docetaxel last year. PSA still undetectable, testosterone in single digits, no bone pain, and PET scans 2 years ago and last month show interval resolution of my one pelvic bone met. Hopefully, based on your diagnosis and the info you provided, you will be in the category of men for whom it will be effective for many years.
The way I look at it, the longer the ADT works, the more time you buy for new drugs and combo therapies to be approved that will give you even more time, maybe even a cure for metastatic PCa sometime, hopefully during our lifetimes.
I agree with Litlerny, it varies just like prostate cancer varies from guy to guy. I was diagnosed with stage 4, Gleason 9 and extensive mets in March 2014 been on triple ADT since DX, PSA remains undetectable but I still take it a month at a time knowing this can change. I've also had chemo and radiation, take Metfomin and use estradiol patches for ADT SE's and as another tool in the fight. I know it probably won't last forever but in the meantime new treatments are being developed and being made available.
My initial treatment for GS 9 PCa was radiation and two years of ADT after which I was in remission for a year. Went back on ADT and became castrate resistant and metastatic 9 months later. As has been said it’s highly variable. Good luck.
The mean time to failure of ADT is roughly 2 years. For every man who makes 15 years or more there must be quite a few that failed in 6 months or less.
Too many doctors are either horrible manipulators or ignorant of basic math and statistics. I go with ignorance but there are certainly some who know better, and all should know better.
In addition to the problem of a mean time to failure, talking about men who go 15 or 17 years brings in survivor bias. You rarely hear doctors talk about their patients who have died; some don't even know. The uro who left the "you have cancer" message on my answering machine never contacted me again. Limiting the discussion to men who have been on ADT for years will certainly make it look like an effective treatment. When looking at all men who go on ADT, the picture is a lot more complex.
Then there is the question of quality of life. ADT most certainly reduces it. Some men resent the effects more than others, some men have worse effects than others. How to weigh those issues is a completely personal choice.
Doctors like to say "you can't enjoy your life if you are dead," which is an argument that quality of life has no weight at all, and that only lifespan is worth pursuing. That's why we end up spending some enormous fraction of health care dollars on the last few weeks of a person's life.
One thing about ADT is that you can stop it. It might make sense to try it for a few months. If it helps and you feel OK, great. If it doesn't help you can try something else. If it helps but you feel terrible, that is more difficult decision, but the only way to know is to try it.
I've been on Lupron Depot for 4 1/2 years (injection every 4 months.) PSA is current 0.26 Went on it about 3 years after external beam radiation failed (40 treatments). I was diagnosed in 2010 with PSA 6.8 but bouncing around, Gleason 7 (4-3) and 10 of 12 samples cancerous. My radiation oncologist never stated how long the ADT would work.
Yes. PSA after radiation was 0.7. Three years after that it was about 3.0. Since PSA was now more than 2 above nadir of 0,7 I went on Lupron. Fatigue is more of a problem the longer I am on it but not complaining as I'm enjoying life. I feel like every day is a bonus since I lost my left kidney to kidney cancer at age 44 (tumour the size of an orange). I'm now 73.
A key to how long IHT will work is one's Gleason score. 7 and lower gives you a much better chance of longer term effectiveness. 8 to 10 bad news, the higher the more aggressive is the cancer and the less treatment will work, and for shorter period of time.
I was Gleason 9 post-RP and Lupron only worked for a year. I got another year by adding in Casodex. I just started Apalutamide and my PSA is going down again. So yes, there is no answer for your question. What you experience is probably not going to be the "average" so there is no point in trying to get an answer.
Its a roll of the dice. No one answer for all. Don’t predict bad outcomes. I believe in positive imaging . I’m no visable signs or Psa for 3yrs now. Fingers and toes crossed praying and trying to live right. The Dr.s don’t know it all. .. don’t go nuts thinking about what “could” go wrong. I’ve done way to much of that.. Fruitless.. do anything to take the mind off our deadly little friend.. half of the battle is keeping gloom and doom out and finding a little daily happiness.. no guarantees for any of us fine fellows. Some guys go for decades on adt other fail in months.. ask a Pc specialist if you can.. stay upbeat.
where THE chemical pneumonitis was caused by a Drug Nilutamide, replacing Bicalutamide
given to me for the PC treatment, as a side-effect.
I was overloaded with unnecessary antibiotics and other drugs,was 2 months on oxygen and almost dyed.
SO NOT TAKING ANY ADT DRUGS IN CERTAIN PC SITUATIONS CAN POSSIBLY GIVE YOU 15 YEARS OF LIVE .?
?
In my case,
the only treatment should have been to remove the drug
and be treated with antiinflamatory Corticosteroids.
This CHEMICAL PHEUMONITIS IS REVERSABLE,
but many doctors do not know about this.
I had to diagnosed myself and later my DX was confirmed by 3 specialists
Please see this from Mayo clinic:
Patient Care & Health Information
Diseases & Conditions
Pneumonitis
Patient Care & Health Information
Diseases & Conditions
Pneumonitis
Sections
Overview
Pneumonitis (noo-moe-NIE-tis) is a general term that refers to inflammation of lung tissue. Technically, pneumonia is a type of pneumonitis because the infection causes inflammation. Pneumonitis, however, is usually used by doctors to refer to noninfectious causes of lung inflammation.
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Common causes of pneumonitis include airborne irritants at your job or from your hobbies. In addition, some types of cancer treatments and dozens of drugs can cause pneumonitis.
Difficulty breathing — often accompanied by a dry (nonproductive) cough — is the most common symptom of pneumonitis. Specialized tests are necessary to make a diagnosis. Treatment focuses on avoiding irritants and reducing inflammation.
Symptoms
The most common symptom of pneumonitis is shortness of breath, which may be accompanied by a dry cough. If pneumonitis is undetected or left untreated, you may gradually develop chronic pneumonitis, which can result in scarring (fibrosis) in the lungs.
Signs and symptoms of chronic pneumonitis include:
Shortness of breath
Cough
Fatigue
Loss of appetite
Unintentional weight loss
When to call a doctor
Call your doctor anytime you have difficulty breathing, no matter what might be the cause.
Request an Appointment at Mayo Clinic
Causes
Bronchioles and alveoli in the lungs
Bronchioles and alveoli in the lungs
Pneumonitis occurs when an irritating substance causes the tiny air sacs (alveoli) in your lungs to become inflamed. This inflammation makes it difficult for oxygen to pass through the alveoli into the bloodstream.
Many irritants, ranging from airborne molds to chemotherapy drugs, have been linked to pneumonitis. But for most people, the specific substance causing the inflammation is never identified.
Pneumonitis causes may include:
Drugs. A variety of drugs can cause pneumonitis, including some antibiotics, several types of chemotherapy drugs and medications that keep your heartbeat regular. An overdose of aspirin can cause pneumonitis.
Molds and bacteria. Repeated exposure to some molds and bacteria can cause the lungs to become inflamed. Specific varieties of mold-related pneumonitis have received nicknames, such as "farmer's lung" or "hot tub lung."
Birds. Exposure to feathers or bird excrement is a common cause of pneumonitis.
Radiation treatments. Some people who undergo radiation therapy to the chest, such as for breast or lung cancer, may develop pneumonitis. Pneumonitis also can occur after whole-body radiation therapy, which is needed to prepare a person for a bone marrow transplant.
Risk factors
Occupations or hobbies
Some occupations and hobbies carry higher risks of pneumonitis, including:
Farming. Many types of farming operations expose workers to aerosolized mists and pesticides. Inhaling airborne particles from moldy hay is one of the most common causes of occupational pneumonitis. Mold particles also can be inhaled during harvests of grain and hay.
Bird handling. Poultry workers and people who breed or keep pigeons are often exposed to droppings, feathers and other materials that can cause pneumonitis.
Hot tubs and humidifiers. Moldy conditions in hot tubs can trigger pneumonitis because the bubbling action makes a mist that can be inhaled. Home humidifiers are another common reservoir for mold.
Cancer treatment
Some chemotherapy drugs can cause pneumonitis, as can radiation therapy to the lungs. The combination of the two increases the risk of irreversible lung disease.
Complications
Pneumonitis that goes unnoticed or untreated can cause irreversible lung damage.
In normal lungs, the air sacs stretch and relax with each breath. Chronic inflammation of the thin tissue lining each air sac causes scarring and makes the sacs less flexible. They become stiff like a dried sponge. This is called pulmonary fibrosis. In severe cases, pulmonary fibrosis can cause right heart failure, respiratory failure and death.
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High Gleason low PSA - quit ADT? 
High-Dose Transdermal Estradiol as ADT
ADT Effectiveness
2 or 3 yrs ADT
