Intermittent ADT

[6357axbz]

Is anyone on this site who is oligometastatic mHSPCa with mets in the bones undergoing intermittent ADT? I have decision to make over the next 6 months if I stay on ADT continuously or take the intermittent route. I am told if I go intermittent and stop ADT, than once my PSA, which is currently at 0.2, goes to approximately 2.0 then I would resume ADT. During the no ADT phase I would monitor PSA monthly.

[Tall_Allen]

In Hussain’s RCT, there seemed to be an advantage in favor of continuous for men with few mets.

There is no standard way to do intermittent ADT Targets can be set variably for PSA, PSADT, testosterone level, time off, radiographic progression, or QOL.

[6357axbz in reply to Tall_Allen]

What is Hussain’s RCT?

[Tall_Allen in reply to 6357axbz]

Maha Hussain was lead investigator on a large randomized clinical trial on the subject.

[6357axbz in reply to Tall_Allen]

Thanks TA, I’ll dig into that literature.

[Tall_Allen in reply to 6357axbz]

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

They did a subgroup analysis of men with low volume mets.

[snoraste]

I started my intermittent two months ago. The target, as Allen mentioned, depends on the specifics of your case. Have you considered metastasis directed radiations?

[6357axbz in reply to snoraste]

For this trial my RO will zap individual Mets once PSA begins to rise after stopping ADT if I choose to go intermittent.

[GP24 in reply to 6357axbz]

Do you have the NCT number of that trial? Combining radiation to the mets with intermittent ADT makes good sense to me. Should result in long holidays.

[6357axbz in reply to GP24]

Study #2018-0349

EXTernal beam radiation to Eliminate Nominal metastatic Disease (EXTEND): A randomized phase II basket trial assessing the efficacy of upfront local consolidative therapy (LCT) for oligometastatic disease

[GP24 in reply to 6357axbz]

I believe it is beneficial to combine local therapy with ADT and not to rely on ADT only. So I personally would take part in this trial.

mdanderson.org/patients-fam...

I looked at the efficacy of ADT and the duration is much longer, if the primary tumor had been treated before. So if you get IMRT to the prostate, this can already be very beneficial. Treating the bone mets can be an additional benefit.

Klotz mentions survival of more than ten years when the prostate has been treated:

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

[6357axbz in reply to GP24]

In this trial I took 6 months Lupron followed by imrt to prostate (only 3 sessions left 🙃) while continuing Lupron. I also added abiraterone/prednisone after week 4 of imrt.

[GP24 in reply to 6357axbz]

So in about six months you have the option to choose continuous ADT or radiation of the mets combined with intermittent ADT? Since I prefer QOL over ADT, I would choose intermittent ADT with radiation. Hoping for long breaks resulting from the radiation.

Klotz believes in intermittent ADT. He mentions:

Although IADT is widely accepted for the non-metastatic PSA failure patient, it is still controversial for use in metastatic castration-resistant prostate cancer (mCRPC).

Dr. Klotz summarizes ten Phase III trials for IADT, each involving over 100 patients. These results consistently showed that IADT is non-inferior or had no difference compared to continuous ADT. The only exception to this observation was the controversial inconclusive results from SWOG 396. The SWOG 396 is the study by Hussain mentioned by Allen.

grandroundsinurology.com/mi...

[6357axbz in reply to GP24]

Not quite. I have now decided on intermittent ADT which means stopping my Lupron/abiraterone/prednisone when the current 6 month injections wears off. We’ll monitor PSA every month and as soon as it reaches 2 I’ll go back on ADT and get the Mets zapped.

[GP24 in reply to 6357axbz]

When will the next break start then?

I would modify the protocol if I may Let the PSA go up to 5 before starting ADT again. At a PSA value of 2 or less start zapping the mets -> the PSA value will go down and you will get a longer break.

[6357axbz in reply to GP24]

It seems they like you to be on adt for a certain amount of time prior to radiation although I’m not sure this applies to sart radiation to mets

[GP24 in reply to 6357axbz]

ADT is usually combined with primary radiation with IMRT. For salvage RT this is not always done.

However, it depends what radiation they will use. For SBRT or SABR, and they may use that, you need no ADT:

ascopost.com/News/59410

[6357axbz in reply to GP24]

I’ll be on adt for life (either intermittent or continuous) as long as I remain HS. Once PSA climbs up to 2 vacation is over and time to go back on ADT, regardless of radiation to Mets.

[Magnus1964]

I am not a fan of intermittent ADT. if a drug has stopped working then move on to something else.

[Schwah]

This study was for only six months of ADT before they stopped and it did not include the latest protocol of including Zytega/prednisone with the adt. I did both for 21 months and zapped my 3 mets at the start. I will be going in my “vacation” next week. I’m at .02 PSA. Extended use of adt has it’s own series of health issues. So many unknowns so each of us must listen and read and then make our own informed choices and not look back. Good luck. Let us know what you decide.

Schwah

[6357axbz in reply to Schwah]

Schwah, are you still Hormone Sensitive?

[Schwah in reply to 6357axbz]

It would seem that way with .02 (undetectable) PSA.

Schwah

[CalBear74]

My urologist here in FL was influenced by Hussain's data so when we moved here (FL) in 2016 he said he was taking me off the intermittent schedule and dropping Casodex. Since then I have been on Lupron only and I am still hormone sensitive. I was diagnosed in 2012, stage 4, two mets to pelvic bone. I qualify as oligometastatic. No RP or radiation treatment since dx because of mets.

In June 2015 I began taking IP-6. The subsequent drop in PSA puzzled my AZ urologist and he did a DRE and could not find any palpable nodules. I did not tell him about the IP-6 because he scorned natural supplements (eventually I did). When we arrived in FL, my new urologist read my medical history and did not believe the note about the disappearing nodules. He gave me his most thorough DRE and finally agreed there were no nodules.

In 2017 Moffitt Cancer Center could not find any evidence of pelvic bone mets. I continue with the IP-6 regimen along with Lupron. My oncologist has not yet made any changes and I have been seeing him for a year. For more info on IP-6 and prostate cancer, go to pubmed and research the experiments of Dr. Rajesh Agarwal at the University of Colorado-Denver School of Health Sciences. The leading expert on IP-6 in the U.S. and probably the world, is Dr. AKM Shamsuddin at the University of Maryland Medical School. His text (2011, Amazon) is very helpful reading. He personally told me the disappearance of the nodules in my prostate is consistent with his studies: IP-6 can normalize cells and/or trigger apoptosis with a heavy enough dose in prostate cancer cells. As I said above dropped the Casodex and we went to a continuous schedule.

You might find these resources helpful:

healthunlocked.com/advanced...

ip-6.net

Good luck.

CalBear74

[Schwah in reply to CalBear74]

I was unable to find your articles on dr Agarwal. Can you please provide links? Does Dr Agarwal personally profit from the sale of IP-6?

Schwah

[CalBear74 in reply to Schwah]

I don’t know anything about his personal investments. He does not endorse any products. Search pubmed.gov using his name and prostate cancer and Inositol hexaphosphate. Sometimes “phytate” is also useful in searching for his publications. That is the old name for IP-6.His publication list is quite extensive.

[Hidden in reply to CalBear74]

Thanks Cal bear

[luvhealth]

My husband has done intermittent ADT with Firmagon for 3.5 years, in the beginning only needing a shot about every 4-5 months. He had 7 bone mets at the beginning. Some have since healed. And this past year, more appeared in his vertabraes. He'd even let his testosterone rise up a ways to help his bone health. We also started the Gerson Therapy at diagnosis, juicing, vegetarian diet and coffee enemas. Then PSA started climbing last August, bone pain started so he reluctantly started Xtandi along with ADT. It helped greatly, and he went into remission again. But Xtandi has lasted for 8 months (just about what they say) and his PSA is rising, now around 62 as of this Monday's blood test. We are now starting the 2nd week with Fenbendazole using Joe Tippen's nutritional regiment added to everything else we do. No bone pain so far, thankfully. Only option left for us is chemo and he doesn't want that. So long and short... intermittent with adjuncts worked as well as straight orthodox protocol. Our oncologist said that my husband has done better than most of his patients. Hope this background helps.

[6357axbz in reply to luvhealth]

Thanks!

[jdm3 in reply to luvhealth]

Very interesting. The Febendazole and Tippen protocol have come up several times through research and conversation. I hope it works as well for you as it did for Tippen. Please keep us posted. All the best, Josh

[luvhealth]

PS: If we had known about Fenbendazole in the beginning, we would have hit it hard. ADT has really wreck my husband, no muscles strength and side effects. Have you checked Jane McClelland's new book "How to Starve Your Cancer"? Good stuff there, gotta hit PC in all pathways, not just one with ADT. Best to you.

[Hidden in reply to luvhealth]

Thanks I'll get the book. I eat very sparingly and only healthy foods. Not only has it stopped any weight gain from ADT it makes me feel better.

The less sugar the better I feel. Exercise is the secret weapon to stop the fatigue

[Hidden]

Thanks Nalakrats

just to be clear your MOS say that intermittent ADT is better than continuous ADT for those of us with a few bone Mets? How long do you have to be on ADT until you take a vacation?

[Hirsch]

russian roulette? if it works why are you wanting to go intermittent?

[6357axbz in reply to Hirsch]

Hears the history and reasoning for intermittent ADT

wired.com/story/cancer-trea...

[Hidden]

Always appreciate your candor.

[Break60]

I did that from 2014-2018 then switched to estradiol patches full time due fewer side effects. But my vacations didn’t last long. See my profile.

Bob

[6357axbz in reply to Break60]

Thanks Bob, very interesting history and helpful. Keep us informed on how the patches work out. It seems like you’ve been making the right decisions.

[Break60 in reply to 6357axbz]

Hope so. Thanks . I’ll report any adverse changes. I did have a lower back MRI this week due to pain which turned out negative for mets but normal deterioration for a 75 year old trying to continue to play golf with a T level of 10!

[Hidden]

I wish all good luck. For me the choice was so simple. With two Mets to my spine, Lupron/Eligard and a six months chemotherapy trial. I faced the reality back in 2004 that they only way to kill a systemic disease is by dumping poison through the vascular and lymphatic systems. So glad I did while my body was strong, tumor burden minimal, and before co-morbidities set in. However, with the new drugs to battle systemic disease, then it may be the way to go. I just don’t know. What I do know, with systemic disease, if you want your PSA &T to rise, stopping hormone injections is the way to go....

GD

[Break60 in reply to Hidden]

I stopped hormone injections and am using patches. Imho better and way cheaper.

And T and Psa are fine.

Bob

[6357axbz in reply to Break60]

Did u begin using patches immediately after your hormone injections expired or did u wait awhile?

[Break60 in reply to 6357axbz]

I waited til psa rose after my last adt vacation in 2018 , got the PSMA ga68 pet ct had two mets radiated with 30 grays each of SBRT ( 3 sessions per met) then decided that instead of going back on Lupron I switched to the patches after reading the PATCH clinical trial results , showing them to my Urologist and talking to a Gent who has used estradiol for 15 years with no recurrence. My profile has most of this info.

Bob

[PhilipMac]

I was on ADT (Zolazex and Dutusteride) for a number of years. I also had radiation treatment to the prostate to debulk the cancer. my PSA fell to less than 0.01 and stayed there for 2 years. My MO and I then decided to stop the Zoladex and my PSA has very slowly increased over the past 2.5 years to .32. When my PSA reaches 0.5 I am going to have a PSMA Pet scan. If this shows up one or two hot spots then they will radiate them. If there are too many to radiate, I will go back on to Zoladex. If no hot spots at 0.5 then I will wait until PSA gets to 1.00 and repeats the process. Hope this helps?