Should I do more?

[Break60]

PSA decreased from 1.4 to .355 in one month after going back on ADT after five month holiday . This time trelstar only; stopped casodex and dutasteride. Had sbrt to two bone nets.

So I’m still castrate sensitive (T = 9.0) after 4 1/2 years of IADT and SRT to mets discovered on each holiday in 2015, 2017 and 2018.

See profile for details. The one major positive seems to be that I have low volume mPCa ( oligomets).

So the question is “should I fix something that ain’t broken” or should I try to drive PSA down to zero? At this point I don’t think I’ll take any more ADT holidays but I can’t help but wonder if the holidays , albeit brief, have prolonged the efficiency of first line ADT?

Bob

[shueswim]

Great news Bob! When I visited Johns Hopkins last fall they talked about the importance of ADT holidays - to give you a break from the side effects and presumably to lengthen the time that the cancer is sensitive to HT. Glad to see the theory worked in practice in your case.

I've yet to start long term ADT but certainly plan to incorporate these holidays when I do. Just curious...during your holidays, how far does your T levels rebound? I was on ADT for 6 months a few years back in conjunction with adjuvant RT. My T levels rebounded slowly, getting back to "normal" in about 6 months after it ceased.

[Break60 in reply to shueswim]

Mine never gets back to normal in six months . Typically not more than 100

[Tall_Allen]

iADT doesn't prolong survival, it gives you a break from side effects. If it's not giving you a break, it's not worth doing.

[Break60 in reply to Tall_Allen]

TA

I agree it's not giving me a break but my unstated question is, given that I've remained castrate sensitive on ADT3 and now ADT(1) is there anything to gain by adding say, zytiga or xtandi , and (2) has IADT prolonged castrate sensitivity? My inclination is to not add anything unless PSA starts to rise aka "don't fix what ain't broke"

[Tall_Allen in reply to Break60]

(1) How can you add Zytiga or Xtandi if you are not newly diagnosed? Can you afford to pay for it out of pocket?

(2) iADT does NOT prolong survival

[Break60 in reply to Tall_Allen]

TA

I wasn’t aware that second line ADT is not helpful or approved when first line fails for guys like me who are far from being newly diagnosed.

[Tall_Allen in reply to Break60]

I didn't say it's not helpful. You said you are still castration SENSITIVE, which means that first line has NOT failed.

[Break60 in reply to Tall_Allen]

No it hasn’t failed. I was simply asking if adding second line before first line failure was advisable and I guess you’re saying it isn’t necessary nor would it be paid for by Medicare.

[RICH22]

trust your instincts, brother. casodex and finasteride for me has kept my PSA indectable while keeping my T good and high - good because T is great stuff not just as male juice but for many various metabolic functions. T may be food for PCa, but if the PCa is blocked from using it, i want as much as possible in my manly blood. :o) -- RT, RP and surgical castration are last resorts - kind of barbaric compared to popping pills or getting injections, imho, but they are viable options when all else has failed.

[Break60 in reply to RICH22]

RICH22

I’m surprised your T is still ok yet PSA is undetectable on casodex and finasteride. Aren’t they supposed to reduce T to castrate level?

Bob

[RICH22 in reply to Break60]

no. lupron and its cousins stop the testes from producing Testosterone. casodex prevents the T-receptors of the cancer cells from using the stuff. so most drs want you on the lupron AND casodex- double whammy. reduce T and reduce cancer cells' ability to use T. for now, i'll just do the casodex. if PSA goes up, i'll add the lupron or have testes removed. got no more use for them other than play toys. lol

[Break60 in reply to RICH22]

I was on casodex and dutasteride (triple blockade) for years but dropped them a couple months ago

[Break60 in reply to RICH22]

What is your casodex dosage? I was under the impression that 150 mg of casodex was an alternate type of ADT to an LHRH agonist and was used to reduce T as well. I’m shocked that you’re keeping Psa diwn without lowering T to castrate levels.

[RICH22 in reply to Break60]

only on 50mg casodex, with 0.4mg tamsulosin and 5mg finasteride. fwiw, i've only been on ADT for 6 months so far.

i also use a 10-herb suppl. Zyflamend. also 200mg Mag. Citrate, 125mg vit D3, 50mg zinc gluconate and saw palmetto.

[Break60]

Thanks

Keep us posted !