I know from past posts here, and reading many articles and studies, that the criteria for starting and stopping intermittent ADT (IADT), or doing it at all, can be controversial. Those posts from a search I did here, have been read.
Sorry for rehashing the topic, but now the possibility of it is more real to me.
For example, the different criteria for starting it, as stated by various drs or studies varies a lot, ie:
- how long to have been on adt before starting iadt ?
- what the nadir psa should be before starting iadt ie some say, for those who have not had surgery but just imrt - <0.1 while some studies allowed higher numbers
- how long that nadir psa should have been at that level while on adt ?
- can one with metastases go on it at all OR can one with lymph node metastases go on it if imaging has shown it has not spread to bones ? or if one has spread to bones can they go on it also ?
====> Thus all I can do here is ask for your thoughts and opinions, as relates to my own situation ? I apologize for re-hashing the topic once again. Am considering it, my dr is not a gu medical oncologist and I won't be able to travel to see one, so my research becomes even more important.
My history and situation:
a. gleason 7(4+3) multiple cores - 2010
b. imrt with 6 mos of ADT - 2011, no surgery or other treatments done
c. psa starts rising past 0.2 - 2015
d. psa gets to 4.5 and axumin scan done - July, 2017
e. axumin scan shows spread to various pelvic lymph nodes and a bit further up
(para-aortic). It does not see any bone issue.
f. several radiation oncologists felt that imrt to pelvic area and above
would carry too much risk to other organs and advised just ADT.
(even though original imrt did not radiate the pelvic area)
g. ADT started - August, 2017 - is only lupron and not ADT 2 or 3
h. psa was 0.3 for a few months, then as of 2/2018, 0.2, 4/2018 was 0.2
Testosterone has been <3 (don't know if thats the labs lower limit or not)
(next psa and T labs will happen soon and of course I realize those results
might have an impact on this sitution)
i. age 71
j. ADT side effects as per labs show some anemia, some elevation of LDL, and
can only assume the other effects related to bones and muscle and other things
are happening but have no way to know at this time
===> thus am asking for your feedback on IADT in general and for my situation
and especially related to being metastatic
and your feedback on your own experiences on it.
My dr encourages me to do this research, and understands as a community oncologist that this research is even more important for me, and I am not able to travel to see the pca experts.
And in case this makes a difference, am on ADT 1 only and dr institution not believe in adt 2 or adt 3 - just mentioning this as a fact, not wanting to revive any discussions about that.
shows many drs interviewed do not recommend it if metastatic
but unlike some other studies, they did not differentiate between far and near metastases.
Sorry for such a long post, I didn't intend it be so long.