Intermittent ADT

[Tommyj2]

Are there specific indications for Intermittent ADT?? Would it potentially lengthen the time to Castration Resistance??

[pjoshea13]

The reason for interest in Intermittent ADT [IADT], IMO, is the morbidity associated with continuous ADT. The idea is that QOL improves during the off-phase. There was a lot of resistance to the concept in the early days the concern being that survival might be significantly shortened. IADT will not increase survival.

QOL doesn't necessarily improve much, because testosterone [T] takes many months to recover & usually doesn't return to the previous high. & many men are below or near the cut-off for hypogonadism. I don't believe there has been an IADT trial with T restoration in the off-phases.

onlinelibrary.wiley.com/doi...

ncbi.nlm.nih.gov/pubmed/243...

ncbi.nlm.nih.gov/pubmed/248...

ncbi.nlm.nih.gov/pubmed/256...

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

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

-Patrick

[Tommyj2 in reply to pjoshea13]

Thank you Patrick... it's not the news I would have preferred to have heard but it's important information none the less..

[Tall_Allen]

IADT can be used in metastatic or recurrent men who are hormone sensitive. It does not lengthen the time to castration resistance - it just gives you a break sometimes.

[Tommyj2 in reply to Tall_Allen]

thank you allen. Good ( bad : ) to know.

I'm just noticing ( talk about late to the party) that when I post a question previous posts in the topic area " magically" appear to the right.... I'll try reading those first next time.

[Spaceman210 in reply to Tall_Allen]

Trying to understand further - are you saying even total calendar time to CR is not different? If so it would seem to imply someone who would get CR under continuous ADT after 18 mos, would still be CR after 18 calendar mos even if only half of that were on ADT.

[Tall_Allen in reply to Spaceman210]

Correct. Castration resistance has multiple pathways and will occur even without ADT. It is part of the natural evolution of prostate cancer.

[Spaceman210 in reply to Tall_Allen]

Varies with disease burden though? Tanya Dorff told me a week ago for very low PSA / disease burden in context of optional inclusion with SRT, that it would not accrue to CR.

[Tall_Allen in reply to Spaceman210]

It takes longer from an earlier starting state, of course

[Spaceman210 in reply to Tall_Allen]

Thanks. I see there are other risks for PSADT shortening and selection promoting more aggressive behavior. Recommendations in my case have varied, context of being worth it for SRT inclusion or not.

[Tommyj2 in reply to Tall_Allen]

So then...someone might start OUT Castrate Resistant? Or does the cancer need to have something to "tweak" it into resistance??

[Tall_Allen in reply to Tommyj2]

Whether some mutated cells were originally there or mutations accumulated over time is unknown. My guess is that both occur.

[Break60]

I used iadt and am still castrate after five years. But I believe my low volume ( oligomets) might have something to do with it.

My off periods were only around six months since Psa started climbing quickly.

[Tommyj2 in reply to Break60]

Thank you for the reply... how was it decided to use IADT for you rather than continuous ? Your request or MD suggestion?? Did you feel any better during your off periods??..... Frankly I am trying to decide if I even want to START hormone therapy or just leave it to fate to claim me when it will..... I have avoided ADT for 7 years now and my doubling time is rather slow....Bone scan is clean ( though I have learned from this group that this does not guarantee that there are no bone mets...just none large enough for the Bone scan to detect..... If I have a reasonable expectation of getting another 7 years of QOL without ADT I think I would do without.... I have no particular desire to be around for an extended period of time ( unfortunately one says this when there is no immediate danger of dying in the next couple of years but my tune could change drastically 7 yrs out...... ) Again....thank you for sharing your information....

Bob

[Break60 in reply to Tommyj2]

You don’t gave a profile so we can’t see your history. But you say you’ve avoided ADT for 7 years and have slow Psa doubling time which implies you’re very low risk. Why are you worrying about it ? What’s going on?

[Tommyj2 in reply to Break60]

Couldn't get the system to accept my profile the last time I tried....perhaps I was doing it wrong?? Where does one go TO add a profile??.... Short Story.... Dx'd Gleason 6 at first Biopsy then Gleason 8 at second Biopsy... one course of EBRT no hormones or "extras"... PSA rising slowly over 7 years beginning at .2 and creeping up each year to high of 5.9 now....PSADT with online calculator is 1.73yrs..... Cancer is in there...just don't know where yet.... Bone Scan negative now on to PET probably..... clearly not in as bad shape ( so far) as many here but Urologist is STRONGLY recommending ADT.... Hence my questions....

[j-o-h-n in reply to Tommyj2]

In 7 years you'll be saying holychit they went fast....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 04/22/2019 6:27 PM DST

[Break60 in reply to Tommyj2]

Well you qualify for a free ct pet with axumin because you’re Psa is over 2.0 and you have the definition of recurrence . I would certainly do that. It may be just in lymph nodes which you radiate with IMRT but you’ll be advised to have ADT to help weaken the PCa to aid the radiation. It impacts everyone differently. You’re slow doubling time is a very favorable factor. Good luck.

[tallguy2]

My second PET with Axumin was also "free," even though my PSA dropped from 2.5 before taxotere chemo to 0.2 afterwards. Some insurance, like mine, paid for the post-chemo, low PSA PET. In my case I was able to determine that I was oligomatastatic after the cehmo. Actionable result!