Intermittent ADT

[jholmq]

Does anyone know what the overall survival stats are between continuous ADT and intermittent ADT? Is intermittent ADT still part of standard of care?

[pjoshea13]

Going back a bit, there was general resistance to intermittent ADT [IADT]. Eventually, there was acceptance, but only for non-metastatic disease. I don't know how recent studies have affected its use in metastatic disease. Looks like IADT is non-inferior to continuous ADT [CADT], but the 3 papers below are probably not the last word.

2014 - Finland:

"Comparison of intermittent and continuous androgen deprivation and quality of life between patients with locally advanced and patients with metastatic prostate cancer: a post hoc analysis of the randomized FinnProstate Study VII."

"IAD is as efficient as CAD in treatment of locally advanced and metastatic prostate cancer. ADT improves quality of life in M1 patients, with IAD offering extra benefit."

ncbi.nlm.nih.gov/pubmed/246...

2014 - Germany:

"IADT has been investigated in several phase II and phase III studies in patients with locally advanced or metastatic prostate cancer, in an attempt to delay time to tumour progression and reduce the side-effect burden of ADT. In selected patient groups IADT is no less effective than continuous ADT, ameliorating the impact of ADT-related side-effects, and, to a degree, their impact on patient health-related quality of life (HRQL)."

ncbi.nlm.nih.gov/pubmed/244...

2013 - Italy:

"Intermittent androgen-deprivation therapy in prostate cancer: a critical review focused on phase 3 trials."

"The evidence indicates that IAD is not inferior to continuous ADT."

ncbi.nlm.nih.gov/pubmed/236...

-Patrick

[jholmq in reply to pjoshea13]

Thanks Patrick.

[Tall_Allen]

It depends on the situation. Are you detectably metastatic (bone scan/CT) and if so, how many mets.

[jholmq in reply to Tall_Allen]

Detectable metastatic, unfortunately yes. At least 8 bone mets.

[jholmq in reply to jholmq]

No organ of lymph mets.

[Tall_Allen in reply to jholmq]

The Hussain study could not rule out that that iADT might be inferior to cADT. They found that cADT was better in men with few metastases, but they could not find a significant difference for men with multiple mets.

nejm.org/doi/full/10.1056/N...

[MichaelDD]

I was diagnosed with multiple mets (more then 10) both lungs. Largest 10mm. No other metastasis anywhere else. Per my MO and the MO at UCSF pretty unique. Because of the uniqueness being just in the lungs they have determined that my Lupron/Zytiga will be intermittent. Giving me and hopefully my lungs a slight "break". That will only happen IF the mets AND the PSA are of course under control/subsiding.

[20PeteG16]

Be careful of information and studies pilgrim, you are "N of 1".

My medical support agreed and I used IADT for six years until re-occurrence. I will admit my quality of life was greatly appreciated.

PeteG

[rrs18]

I was on intermittent ADT for 16 years after my RRP. On full time for last 2 years.

[pete0550]

I'm in UK and potentially a candidate for IADT. Mine was locally advanced (seminal vesicle), zero mets. PSA came down very quickly and as I was struggling with quality of life issues, my oncologist advised me I could come off after 15 months. PSA has crept up since which he advises is to be expected but should plateau. Next test is due next week so I await that with some apprehension. I have a niggling worry that I should have stuck it out for longer but I wake up every morning and life is good. All the best to you.

[LF27]

My MO at Dana Farber has me on IADT. Plan is 9 months on, then a vacation for a period of time tbd based on periodic PSA readings. I'm about 4 months in at this time. Information on my diagnosis in a previous post of mine if curious. All the best to you.

[Patrick-Turner]

I was diagnosed with Pca in Dec 2009, Gleason 9+9 ( horrible score ) then docs opened me in Arpil 2012 to find my Pca was inoperable. I began ADT after that and Psa went from 8.8 to 0.08, at about 18 months, and docs thought Psa had not spread, but years later the new PsMa Gallium scans showed a multitude of mets including bones and it probably had spread before my diagnosis, but the mets remained too small to see in scans while on ADT. I paused the ADT in 2012-2013 for 6 months, and Psa shot up to 8 again, and I went back onto ADT. I had another pause in 2015, and same thing happened, and after each pause my testosterone level went up, giving me a number of benefits, but not for long.

After 2015 ADT pause, testo came back very slowly, and Psa did not go back down to levels seen before each pause, so my guess is that during each pause my Pca gre well, and there was more of it so Psa slowly rose and by 2016 it began to fail.

So If I had stayed on ADT continuously, I might have got another couple of years of suppression, maybe.

Since 2016, I have had 4 PsMa scans, Cosadex, Zytiga, gave 14 months suppression, then they failed and I had 5 chemo shots over 15 weeks this year which pushed Psa from 12 to 45, so I quit that, and have had a shot of Lu177 3 weeks ago, with 3 more to go, maybe, and it looks like Pca will kill me, but maybe Lu177 delays it for a couple of years.

I am 71, 90% vegetarian, BMI 25, waist 100cm, resting HR 50, and I cycle 220km a week to stay fit. I don't smoke, drink, and no junk food.

I don't see any remission is possible, although I might last long enough for some new immune therapy to be here and which works better than Provenge and some interesting work on IT is being done in UK and Germany.

Pca and ADT means goodbye to your former self, Rodger can only be a drain pipe, and for many the loss is traumatic. But I've been single for last 40 years apart from a few flings, so me getting sick and losing sex ability did not upset any woman.

Patrick Turner.