Duration of ADT until castration resi... - Advanced Prostate...

Advanced Prostate Cancer

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Duration of ADT until castration resistence

GP24
GP24

If you ask your doctor how long the ADT will work until castration resistence begins, he will tell you probably two to three years. That is what I also read in many studies.

However, many patients are asked to do three years of ADT after their radiation therapy. Are you usually castration resistent after that?

61 Replies
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I have been on ADT (Eligard) since late 2014, and am not castrate resistant yet. I was already in Stage 4 when diagnosed in 2014 (bone Mets). So far so good... I have met others in treatment who have been on ADT for up to 9 years and are not yet castrate resistant. All the best!

GP24
GP24 in reply to Darcym1

I think the Chemo was beneficial. The Latitude trial reports 7.4 months to castration resistance in its control arm, which did ADT only. CHAARTED reported a much better result when Chemo was added to ADT. This were all patients diagnosed with four or more bone mets.

Darcym1
Darcym1 in reply to GP24

Yes, I had chemo as well - docetaxel for 18 weeks, I think it helped to stabilize things for longer. So far my PSA has remained low, and was over 100 when I was diagnosed. I also cut way back on meat and dairy and lowered stress levels. It’s hard to know if that has made a difference, but hey it can’t hurt. 😎. Best of luck to you.

elainea53
elainea53 in reply to Darcym1

I am not sure what castrate resistance means and how you know you are?

GP24
GP24 in reply to elainea53

Castrate-resistant prostate cancer (CRPC) is defined by disease progression despite androgen depletion therapy (ADT) and may present as either a continuous rise in PSA levels, the progression of pre-existing disease, and/or the appearance of new metastases. (by Dr. Saad)

Greatfaith
Greatfaith in reply to Darcym1

Hi Darcym1, I, too, was diagnosed with bone Mets & finished 6 chemo infusions 4 months ago. I’ve had a 4 3 month Lupron injections. So far, so good, PSA is 0.25. I want to ask you if you’ve ever taken a break from ADT during the past years? Thank you.

tdelpozz
tdelpozz in reply to Darcym1

Have you had any other treatments beside taking Eligard?

In 2016 and 2017, I did nine months of ADT when I had cyberknife for an extra-capsular recurrence five years after brachytherapy for a diagnosis of Gleason 3 + 3. Then I 2018, when my PSA jumped from < 0.1 to 4.48 between April and November (PSADT < 6 weeks), PET Scan found metastasis in about ten lymph nodes (confirmed by biopsy of one of the lymph nodes). Since then I am on Lupron. One question that comes up in my mind: Does the nine month ADT in 2016-2017 count towards becoming castrate resistant?

GP24
GP24 in reply to dac500

From the studies I read, nobody knows for sure. In the study by Crook they assumed that an ADT therapy twelve months before entering the study would not make a difference.

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

On the other hand, Ross suggests you should combine the duration of the treatments.

onlinelibrary.wiley.com/doi...

I did 30 months of ADT and took an 18 month "holiday" off the Lupron. So far, PSA has still responded to the T deprivation that was restarted on 12/14/18

Those are different situations.

(1) When ADT is given adjuvant to radiation for 2-3 years, it is given in the hope that it will clean up any remaining cancer cells, perhaps assisting the immune system in doing so. Castration resistance is not an issue.The hope is for a cure.

(2) When ADT is given as a life-long therapy (intermittent or continuous), either when the cancer is recurrent or has detectably metastasized, the goal is long-term maintenance. Eventually, the cancer will become castration resistant.

Hidden
Hidden in reply to Tall_Allen

Exactly what my oncologist has been telling me

It's important to note that a man usually stays on ADT for life, even after cancer returns following primary treatment. To treat the cancer one stays on ADT to stay at castrate levels. That is, this keeps the testosterone at <50 ng/dl. Of course, the physicians can change the type of ADT.

GP24
GP24 in reply to tallguy2

Klotz stongly recommends a testosterone level below 20 ng/dl while on ADT:

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

The European guidelines already recommend that too:

uroweb.org/guideline/prosta...

tallguy2
tallguy2 in reply to GP24

I understand. I was quoting the NCCN guidelines. (My level is 12.)

Thanks for the update.

Jbooml
Jbooml in reply to GP24

Has anone seen a flow chart of PCa sons and daughters....ive been researching the epigenic causes of different tissue cancer lines...convincing myself that mutations in the grandfather cellline tissue can largely determine ones outcome. Some of these tissue lines are only partially or completely T agnostic.....very interesting stuff. Its logical that the physiology of any organ is susceptible to varied tumour epigensis manifesting mutationally in a host of phenotypes....some having virtually no hormonal dependance.

RICH22
RICH22 in reply to Jbooml

very interesting indeed! but hormonally independent cancer phenotypes would still need to feed on something. Engineering the mutated genotype that created them to feed on a substance that would kill all resultant cell lines would be excellent.

GP24
GP24 in reply to RICH22

The Lu177 therapy is similar to that. It finds prostate cancer cells in the body, attaches to them and radiates them. However, this substance also finds the salivary gland too.

RICH22
RICH22 in reply to GP24

so once again, it's a crapshoot. >sigh< Now i'm wondering which gland is more important, salivary or prostate.... hmmm....

GP24
GP24 in reply to RICH22

Well, it is as specific for prostate cancer as you can get. The treatment is very successful, the hit on the salivary gland is a side effect patients usually accept.

I got about 4 months before becoming CR. The second line H therapy didn't do much apart from slow down PSADT.

GP24
GP24 in reply to Sriyantra

At least the Ac225 therapy worked for you. I personally think it is better to have long gaps between the cycles to recover properly. Do these as needed and do not follow a fixed schedule. You will have to get the next cycle maybe next year and the side effects should be gone then.

Sriyantra
Sriyantra in reply to GP24

Thanks, appreciate the advice.

Its possible to get back to normal by reintroducing Testosterone. You can repeat this process. Please check it out and dont give up.

Pca patients are not castrate resistant after radiation. As to how long some would become castrate resistant, it is different for everyone. Besides, when one drug fails after a few months or years, that does not mean your cancer is resistant to other ADT drugs. You could be on ADT drugs for decades. Case in point, me. I was on Casodex for 5 years, Zytiga for 3 1/2 years and Xtandi for 3 years and counting.

monte1111
monte1111 in reply to Magnus1964

Xtandi 3 years and counting. That is so cool. Usually hear it doesn't work so well after Zytiga. You are indeed an inspiration. Keep on kicking it!

After being detected with metastatic prostate cancer, I was asked to take radiation and put on Casodex & then Eligard.

Within 7 months or less, I was castrate resistant. Is this a "record" for the fastest to castrate resistant or what ?? :-)

GP24
GP24 in reply to whatsinaname

The control group in the Latitude study, which included high risk patients with four or more bone mets, had a median time to PSA progression of 7.4 months. So your seven months are not unusual. Sriyantra mentioned four months above.

See table 3 in the full text of the following report:

thelancet.com/journals/lano...

whatsinaname
whatsinaname in reply to GP24

When I was first detected with MPC, I was not considered by my doctors to be "high risk". In fact, I was told that Eligard alone should work for about 2.5/3 years.

But, now I know how little the doctors really know :-(

The attitude is they dont want to fail so they use anything they can after all sooner or later your body will forget how to make DHT or Testosterone. There are persons who are on Lupron for 20 years and it works forever. I dont know if they know what they are doing.

Sxrxrnr1
Sxrxrnr1 in reply to elvismlv123

Often wonder of those on very long ADT having a cancer that has just on its own accord or result of some therapy gone into remission that has nothing to do with ADT,,,,therefore they may beating themselves up for nothing.

I know of those who seem not to care of the other known health risks they are taking and care not a wit of side effects. This is their life and they cannot let loose of the lifeline that they believe is keeping them in remission.

So their PSA remains very low as does their T. If they were to cease ADT, their PSA may remain low,,,and safe,,and their T would rise to provide a rebirthed QOL.

They might never know. They could haves been completely castrate resistant for years and never known it.

SuppWife
SuppWife in reply to Sxrxrnr1

I wonder the same thing.

elvismlv123
elvismlv123 in reply to Sxrxrnr1

We dont know enough about this to know enough about it. Sounds crazy but its true.

But if your PSA is above 300 and you have a hard tumor on your prostate and Lupron gets you down to 2 and you go from 81 to 96 and dont die from PCa then who won?

elvismlv123
elvismlv123 in reply to Sxrxrnr1

If you are castrate resistant chances are your PSA would rise with ADT as thats its definition. But then who cares since the goal is to keep the PSA low as possible.

We have to be wary that metastasis could occur and no one wants that. IADT may be a good strategy at some point. So you can get QOL during off periods and still feel in control.

RICH22
RICH22 in reply to elvismlv123

totally forgot to ask about IADT in the last 2 consultations! thank you much, buddy!

carlo8686
carlo8686 in reply to Sxrxrnr1

Your guess is probably as good as my dr

Hidden
Hidden in reply to elvismlv123

I often wondered the same thing do they really know what they’re doing

I have been on Lupron for one year and Ziji got prednisone for about 10 months and so far my PSA is undetectable

The heat flashes and side effects are becoming so disruptive especially at night, But I’d rather be alive and deal with them than the alternative

elvismlv123
elvismlv123 in reply to Hidden

much to do about nothing...I had them too but a small price to pay to kill a cancer.

Hidden
Hidden in reply to elvismlv123

Did it work for you?

elvismlv123
elvismlv123 in reply to Hidden

absolutely

15 years of no more worry.

elvismlv123
elvismlv123 in reply to Hidden

I went to at least 10 doctors most were full of s...t. went to Guillianis doctor at Mount Sinai. Called all over the country and sent them my records. I wound up with a doctor in Ca but was treated in NYC. Same Protocol 3x ADT for 13 months and 6 months of regular ADT.

5 years almost to the day on ADT only PSA dropped steadily from 180 to now 6 over the years. Nail biting 24 hour every 3 months as PSA tested

My husband as diagnosed 12/2016 and started Lupron/Casodex in 1/17. He did 6 rounds of taxotere and his PSA was .9. By 9/17 his PSA had gone up to 1.1. He went back on his casodex (without telling the doctor) and his PSA dropped to >.06. The MO didn't believe that the casodex would do that. My husband decided he didn't want to stay on Casodex and since the MO was willing to prescribe Zytiga (it had just rec. FDA approval for early use) so he went that route. That was when the doctor diagnosed him as castrate resistant. There was no progression of mets and no doubling time on the PSA. In some cases, castrate resistant is just a label. Took me a few months to get my head around the fact that while husband is diagnosed as castrate resistant, he really isn't. Currently his PSA is .01.

Break60
Break60 in reply to Union98

What is his T level?

teamkv
teamkv in reply to Union98

So is he just on Zytiga? Why didn’t he want to stay on the Casodex and is he still on Lupron?

I was dx with Stage 4 PCa on March 2017 with a PSA of 415. I immediately went on to Lupron and Chemo. After 4 rounds of Chemo, PSA dropped to 0.1 and stayed there for 18 months. PSA last month was 0.6. Cat and Bone scans from last month showed no known cancer in the lymph nodes (woo hoo). My Onc who specializes in PCa said I am not castrate resistant. He is hopeful by the time I get to becoming castrate resistant, there will be a new drug to administer in lieu of zytiga, xtandi, casodex, etc. So right now, I am not concern as I believe that I am in good hands from both my Onc and the big man above. i am enjoying life and living it to the fullest.

Nick- I get treated in MD Anderson South Jersey

Hidden
Hidden

I’m watching an in-house clinical trial at Moffett where they are doing short term intermittent ADT, take Zytiga/ Lupron until nadir on PSA then stop, when PSA starts to rise, back to ADT. It’s more complicated that I can explain, But so far, mean time to castrate resistance has not been reached but will exceed 38 months. Current national mean time to failure is 16.5 months according to medical histories. Delaying resistance has got to improve OS.

Just to add

My husband was DX 2011 with a G7 and has been on some sort of ADT every since.

Now on monthly injections of Lupron with very little SE. His PSA is 1.4. his T-is 7.

Has had radiation 2 times within the 8 years to his pelvis and rib.

BOOGEE

elvismlv123
elvismlv123 in reply to ROLNCIN1

It doesnt make sense why radiation was done....Unless they happened to look suspicious.

He does not have mets? His PSA has to be more than 10x lower than 1.4 not because 1.4 is a bad number. Its a matter of the right response and 1.4 is not good enough. It should be undetectable meaning .05 or .005. And it has to stay that way for a year. Hes got too much T running around. Needs to be in castrate range below 20ng/deciliter and I will bet you its not. Thats why his SE are not bad. With the right treatment youll get hot flashes and other dumb stuff but tolerable. Doing this half assed doesnt produce a good result. And the disease will hang out a long time.

Muffin2019
Muffin2019 in reply to ROLNCIN1

What do they mean by reference to T count ?

I started off with a PSA level of 130 -140 but scans showed that the tumour was substantially restricted to the prostate and environs, no detectable bone mets, lymph gland involvement, etc.

After the prostatectomy my PSA fell to 2 and then within three months of starting Firmagon, below the limit of detection.

I also had 66 Gys of radiation to the prostate bed.

I have been on Firmagon for just over a year now and my latest 12 month test was still below the limit of detection.

One of my doctors expected me to become castrate resistant quite quickly but the other did not.

I tend to the point of view that castration resistance will take a while to set in, in fact the cancer may be completely dead or at an extremely low level.

I am planning on stopping the Firmagon at the 19 month to point to see what will happen if my PSA is below the limit of detection at that time

tsim
tsim in reply to GeorgesCalvez

My diag was very close to yours, could I ask what your Gleason score was?

GeorgesCalvez
GeorgesCalvez in reply to tsim

My initial Gleason Score was a 7b ( 4+3 ) and I was staged 3b with some perineural and extra capsular extensions and light invasion of the seminal vesicles.

Obviously there is no way of knowing until it happens but I suspect that when the cancer does recur it will be in or close to the prostatic fossa.

I reckon I am in for a long game as I think it will take a while to get round all the drugs and throw out metastases.

My very first alarm was PSA rise from the normal below 4 in 2014 to 12.0. I was dxed with bone marrow cancer at the same time and ignored the PSA rise. By 2017, it was up to 16.9, which I brought down to 14.8 using various herbs and dietary changes. Had resisted biopsy but finally submitted, after 3T mpMRI revealed 2 lesions; GL 4+3, only 1 lesion malignant. ED had been mild but after biopsy, worse. I began Casodex 50mg/day and went 100% impotent, but orgasm still achievable, with retrograde ejaculation. PSA <0.1 for almost 18 months. For married men, sex can be an important factor in QOL. I'm alive, still have my glands, T=500+, which affords all the benefits that a normal T level grants, in MANY other metabolic processes.

I'm 72, with other "co-morbidities" that will kill me before PCa will. At least I'm not in severe pain and can still be independent. Each day is a gift, brothers.

elvismlv123
elvismlv123 in reply to RICH22

Thank You Oh Lord for these thy gifts.. The Sun to shine, The Trees to grow and the possibility of Life for everyone of us!!!!!!Life is a possibility not a gift....

RICH22
RICH22 in reply to elvismlv123

how bout life is the gift of ENDLESS possibilities? I have a terrific set of instructions given to me by a rather brusque primary care dr. whom i liked, even tho the feeling was not mutual. I formatted it in a nice graphic frame and followed it up with my fave quote from Matthew 6:25, which i leave out here, since religion may set off similar fireworks as did my politics. I would say tough tarts but hey, i'm already on too many shit-lists. Enjoy, partner!

TO HEAL BODY AND SOUL

1) Eat a diverse healthy diet of chicken, fish and low carb. vegetables

2) Exercise 30 minutes per day

3) Maintain an ideal weight (BMI of 19 - 25)

4) Sleep at least 7-8 hours per night

5) Be driven by a purpose that benefits you and others

6) Forgive yourself and others

7) Maintain healthy relationships

ELV,

If you are referring to BOOGEE,

Over the past 9 years my husband DID have mets to his pelvis and rib. That's why he had radiation!

His T level is 7 so it's not too much testosterone, it is at castrate level.

He gets monthly Lupron so it's less med. than if it were every 3 month.

He has had several treatments .

He had been on Degarilex but Oncol. switched to Lupron again as he had been on Lupron 7 years ago on a 3 month injection. SE were difficult.

So far this year his PSA had been rising that's why he is at 1.4.

His PSA Starting rising to 1.8 then down to 1.6 now 1.4. Oncol is happy with that.

He does get hot flashes from time to time but SE are tolerable.

Husband still employed and doing well and we are happy with his treatment.

I was only sharing our treatment plan with others.

BOOGEE

Muffin,

T levels or count is Testosterone

Oncol. want your T-levels to be below 20 if you are on any treatment plan. Actually the lower the better as Testosterone is what feeds the tumor or cancer.

BOOGEE

34 months here. Still getting great PSA readings. <0.05

I’ve been on Intermittent ADT for five years plus lots of tx during “ vacations” ( see profile) . The first six months was just Lupron with SRT. Subsequently it was 13 months of Lupron , casodex and dutasteride ( ADT3) each time in conjunction with RT. Now it’s just full time estradiol patches which have few side effects unlike SOC ADT. No supplements or special diet other than lots of salads , little red meat, an occasional egg yolk. T always below 10 . PsA 1.0

Bob

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