Does Intermittent ADT delay castrate resistance?

[mklc]

Greetings to you all this New Year and wishing you good health and joy.

My question is:

Does intermittent ADT (Lupron & Cassodex) delay castrate resistance?

Thank you for your opinion and all best wishes,

Lynn

[pjoshea13]

See:

askdrmyers.wordpress.com/20...

-Patrick

[mklc in reply to pjoshea13]

Thank you so much.

[cfrees1]

Tall Allen has a post on this with links to studies that show that delayed or intermittent ADT does NOT postpone castrate resistance. You might try the Search feature to try to find his post.

[mklc in reply to cfrees1]

Thank you I will do so. The more information the better though for sure I am totally confused and bewildered already!!

I trust you are well and enjoying the New Year.

All best wishes.

[mklc]

good afternoon Nalakrats,

Thank you for sharing your extensive research on this exhausting and exhaustive subject!

My husband's oncologist says he should be on continuous ADT (Lupron and Cassodex) because it took 7 months before the PSA went to undetectable.

The previous 2 ADTs the PSA went to undetectable in a very few weeks.

The oncologist said that IF the ADT is stopped, the PSA MAY not go to undetectable OR it will mean moving to a 2nd generation drug.

He said this isn't based on any study just from his experience.

So in your opinion, should the Lupron and Cassodex be continued for another 8 months as it has been 1 year now on the drugs?

The PSA went undetectable at 7 months, so what is the benefit of the additional 8 months?

this is for my own curiousity.

Thank you for dealing with my endless questions.

[Hidden]

Hi,

Nice profile history details!

I've just started, 09/11/2018, date is real, init PSA 1000+, Eligard (6 month shot) - daily Casodex and Zytiga/Prednisone, current PSA 0.5 - Nalakrats has some assertions about pushing more on getting PSA lower.

Anyway, I'm always asking about ADT vacation, the Dana-Farber team claims, 18 month minimum on ADT, then assessment for possibility. But they flat out don't recommend it, most likely because clinical trials did not reveal much either way with I-ADT.

But, but, but, if I-ADT did demonstrate negative results, then how about QoL? For some reason the QoL is not much of a factor in any of the clinical trials that I've researched on. In fact, physicians don't equate much about QoL with treatments.

Some here are on ADT vacation, I'm looking forward to it...

[mklc in reply to Hidden]

I really appreciate your reply and opinion.

The QOL is really important for my husband and for me the big worry is what happens if the cancer than becomes more aggressive and mutates.

The cancer has for sure changed over the past 15 years and has become very aggressive with a 2 month doubling when he was off the ADT.

I am beginning to think this is a throw of the dice.

It is a serious consideration that such an excellent team at DF recommend 18 months and continuous ADT.

You have an amazing team and DF is one of the best.

I am happy to see you have responded so well to treatment and long may it continue.

wishing you all the very best and Happy new year.

[dockam]

I'm testing IADT right now - had 30 months ADT with the last Lupron shot on 03/31/2017. Had a wonderful "holiday". Never got undetectable, had a nadir of 0.1 from 840 at Dx in 01/2015. Also did 15 Taxotere sessions in 2015. Three years ago I hit 0.7 and started Metformin (1000mg/day) and then that 0.1 nadir. Did a triple Casodex daily of 150mg during the "holiday" Just had a Lupron shot a few weeks ago, the PSA got to 10.2. I have a PSA test next week and will see how the #s respond, T got to 1002 at one point.

Best to y'all - Randy

[mklc in reply to dockam]

Thank you Randy,

What is the reason for being on the ADT for 30 months?

fingers crossed for a happy result for next week's PSA.

Warm wishes,

Lynn

[Tall_Allen]

The more important question is: does it increase survival (it doesn't matter if you're castration resistant or not if you survive just as long)? Continuous ADT MAY (results equivocal) improve survival more in men who have few mets. For men in whom mets have not been detected yet, intermittent ADT seems to be no worse than continuous, but no better either. The benefit is to give you vacations where you get a break from Lupron.

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pubmed/229...

ncbi.nlm.nih.gov/pubmed/224...

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

(many more)

[mklc in reply to Tall_Allen]

Thank you so much Allen,

My husband did a Ga 68 before going back on Lupron & Cassodex and it showed pc in 4 or 5 lymph nodes in the thorax area.

Before this he did a choline c 11 that showed suspicious in the retropreneurial. But this went away after the 2nd ADT.

So I suspect after the 3rd ADT the pc in the thorax area would go away also BUT where would it go next?

My questions are:

1) Is there a pattern where the pc travels through the lymph node system in the body?

2) do you think he should stay on Lupron and Cassodex for 18 months? He has already done 12 months.

THANK YOU so much.

[Tall_Allen in reply to mklc]

(1) Once it's systematic in the lymph system, larger mets can show up anywhere. but why does it matter where?

(2) Long-term ADT is usually used when lymph nodes have been affected.

[mklc in reply to Tall_Allen]

Thank you Allen.

Now we have to discuss with oncologist how best to move forward.

Very grateful for you sharing your knowledge.

best wishes.

[mklc]

I hope you don't mind one more question.

Do you mean by stay the course to be on continuous ADT? And not go intermittent? OR do 18 months and then take a drug break?

Apologies I am a bit of a super detail person!!

Thank you so much.

[mklc]

Thank you Nalakrats.

Much appreciate you sharing your knowledge and experience.

[Joeym1040]

Initially diagnosed in 1999 age 59. Recurrance in 2011 started on lupron. Since then I have been on lupron for a year, then off for about 15 months or until PSA gets to about 8. So far great. No mets yet and will be going back on next month. We are all different, and I consider myself extremely lucky, but has worked for me so far.

[mklc]

So great to hear this and long may it continue.

Thank you for sharing with me as it gives encouragement

Warm wishes and good health.

[j-o-h-n]

Great details.... October 2003, 15 years.... Good for him....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 01/09/2019 4:55 PM EST

[mklc in reply to j-o-h-n]

Thank you John and good health and joy to you too..

[MJCA]

Hi,

I was diagnosed 13 years ago. Initially I was on Lupron for 2 years. If memory serves me correctly, I had 4 more treatments of Lupron each for one year. So, that could be considered intermittent. I am now nmCRPC - non-metastatic, castration resistant, prostate cancer.

It’s going to do what it’s going to do!

[mklc in reply to MJCA]

Thank you for your support.

And well done to you too...

If you don't mind me asking what drugs are you on presently?

Sincere thanks and well wishes.

[MJCA in reply to mklc]

My status just changed. I am on Lupron Depot and beginning Erleada.