mHSPCa Intermittent VS Contiuous ADT

[6357axbz]

I’ve reviewed the trial results but am interested in hearing from anyone who has actual experience with IADT for mHSPCa and how long this was effective before mHRPCa. Thanks.

[6357axbz]

Thanks Nalakrats! I am so happy for you!

How did they determine your PCa was “micro-metastatic”? What is ADT-6? What is your center of excellence? How high did your PSA rise after vacation and before going back on ADT?

[Longterm101]

Nal were you node positive at DX?

[Schwah]

Sounds like you didn’t go back on ADT because your PSA went up but rather had a plan in advance of when to go back on? I just started my “vacation” after 21 months on adt and zytega (and SBRT to my three mets) after a year of PSA at .01 to .02. I had not planned on going back until If and when my PSA rose again. What’s the thinking behind your plan of a year on and a year off?

Schwah

[6357axbz in reply to Schwah]

Schwah, did you have any problems getting insurance to pay for SBRT to your mets?

[PommyB]

At 77 ten years ago I was given PSA results of 79. Having lost a wife 15 years previously to medical mistake I opted for alternative treatment,s, Cancell aka Protocel, for 18 months and PawPaw extract for the following !8 months. These kept the PSA around the same but started to lose effectiveness around the 18 month mark. My then wife of 17 yrs died suddenly and though I lost some of the will to live I started on the Budwig anti cancer diet that at least promised improvement in general health.

After a year things caught up with me and I had a urinary shutdown, forced Foley catheter and a PSA of 138. A nuclear scan showed metastases to right hip girdle and total left ureter and kidney. I was put on pills that precede a Zoladex 3 month depot injection, then the injection and a follow up 3 months later to reduce the size of the prostate before a TURP to get me off the catheter. For those on a Foley Catheter it's not as bad as you might think. You can get a full nights rest, great after being on 2 hr shifts, and I was even dancing for hours at Christmas and birthday parties ! Fortunately I got a cancellation slot and was operated on in April 2014. In Nov the same year a nuclear scan showed no metastases so the diagnosis went back to stage 3 from 4 , the chips from the TURP showed a Gleason 7, 3-4 from memory, and 70% involvement.

On the Zoladex my PSA goes down below Zero, then climbs to around 2 after 6 months but I take natural foods that help keep the PSA down. After that it climbs back up to around 20 at 12 months and I have another Zoladex injection. I went vegetarian after the catheterization, something I should have done before as the Budwig Diet stipulates that. Raw food is most of my diet and my general health is back to what I was in my early sixties. That diet works well for glucose consuming cancers, but not that great for us hormone dependent ones, still, I take no other medications, have no problems and amaze my family by my exploits.

Mental attitude is a great healer, in fact healing by the mind is the greatest, a good place to start would be videos by Dr Bruce Lipton who was the pioneer in epigenetics and the power of the mind to switch genes on or off as well as by dietary means. I have found enough proof that where we are going eventually is a great place to go, so that great bugbear, fear of death is not one I am saddled with, but I have a few adventures planned before that great one.

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

"I have found enough proof that where we are going eventually is a great place to go"

I saw an ad for burial plots, and thought to myself this is the last thing I need.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 06/10/2019 4:14 PM DST

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

It took me a few moments to get that one j-o-h-n ;>) as I plan being cremated!

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

Me too..... but hopefully after I'm dead.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/11/2019 4:46 PM DST

[Rob1053]

I have had this disease for 15 years. I had failure in 2006 and underwent radiation therapy to slow the progression. They administered Lupron in conjunction with the radiation. In 12 -15 I took an Eligard shot when my PSA rose to about 73. I was off it for 2 years and took a Lupron shot when it rose to 88 in 12-17. It is rising more quickly now and was 84 in April.

This may not be the safest approach but I am opting for quality of life rather than just longevity. The half life on Lupron is 6 months so it takes a while for it to leave the body but I enjoy the renewed energy and the improved functions of all equipment.

You have to make you own evaluation if this is for you. I am the only one currently using this approach with my Oncologist.

Good Luck

[jfoesq]

I was diagnosed with metastatic PC 7 years ago at age 54. I had 4 bone mets and another met was found in a lymph node when I had prostate surgery along with the removal of 34 or 36 lymph nodes. Partly due to my comparative young age, my doc did surgery (which back then was pretty radical ) and put me on Lupron intermittently (usually along with Zuniga and prednisone, which was also a newish drug). I was treated intermittently for 6 yrs. The first time I stopped taking the meds I went 20 months between shots, until my psa went from undetectable and rose to somewhere around 4 or so. The 2nd time I stopped the meds, I think I went about 12 months and the last time, I think was about 6 months. For my last treatment with that doc he chose to only put me on Lupron. He no longer sees patients so I am seen by his colleague now who has me taking Lupron only and continuously.

My understanding of the studies indicates that patients with Metastatic PC do NOT live as long as patients who receive it on an intermittent basis. I believe that may be different for patients who do not have Metastatic PC.

Hope this was helpful.

[6357axbz in reply to jfoesq]

Very helpful, thank you.

Are you still hormone (castrate) sensitive?

[jfoesq in reply to 6357axbz]

Yes- Fortunately my PSA has always retreated to undetectable levels when receiving the Lupron with Zytiga (and prednisone) and now while only taking the Lupron. My next lab and doc appointment is in 2-3 weeks. Keeping fingers crossed.

BTW- I forgot to mention that I was a Gleason 9 and otherwise was healthy except for some high cholestoral, for which I take a statin. I believe studies indicate that statins MAY also be helpful in fighting PC.

[6357axbz in reply to jfoesq]

Which station do you take?

[jfoesq in reply to 6357axbz]

Lipitor

[6357axbz in reply to jfoesq]

You wrote, “My understanding of the studies indicates that patients with Metastatic PC do NOT live as long as patients who receive it on an intermittent basis”

Do you mean patients with metastatic PC who do not receive any ADT do not live as long as patients who take ADT intermittently?

[jfoesq in reply to 6357axbz]

Sorry for lack of clarity. I meant the following: It is my understanding (but you can find scientific studies and articles if you google it) that those with metastatic PC live longer when treated with continuous ADT when compared to those who are intermittently on ADT. I hope that clarifies things.

[6357axbz in reply to jfoesq]

Yes it does. Thanks again. I read those studies (trial results) over the weekend and I agree with you. However, you’ve been doing great and beating the odds by a lot. I hope you keep it up. Your story provides some hope for me.

[jfoesq]

Where are you being treated?

Glad my info helped and wishing you the best.

[6357axbz]

MDA

[6357axbz]

Nalakrats, how do you define BCR?

[Schwah]

Does your bi yearly treatment plan include Zytega and supplementing your testosterone? Is the every other year timing a gut feel or based upon some specific theory. Thanks for all you do.

Schwah

[tango65]

Why do you use Proscar and Avodart?

[GP24]

I have to admit, I do not have actual experience with IADT for mHSPCa. However, in case you missed it, this study fits your sitation:

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

Also, I recently looked into various studies to determine the efficacy of ADT. I am sorry to say that usually resistance will occur in less than a year in case there are many bone mets. I do not think it makes sense to do IADT during this period. The LATITUDE trial mentioned 7.4 months only for the control group. Therefore you should combine your ADT with Abiraterone, this will extend the median time to CRPC to 33.3 months.

[6357axbz]

Thanks

[Break60]

I’ve done iadt since 2014. As soon as Psa climbed to near 2.0 I got scans and treated mets with radiation and went back on ADT. See my profile

[6357axbz in reply to Break60]

Thanks, good info. Did you have problems getting insurance to pay for zapping mets?

[Break60 in reply to 6357axbz]

No

Medicare and medigap pays everything at the negotiated reimbursement rate .

I don’t know about coverage for guys under 65.

[GP24]

I forgot to mention, I know a patient who lives over ten years now, initially diagnosed with bone mets. He does intermittend ADT3 and is still hormone-sensitive. I think debulking the tumor did help him. He had his prostate radiated and also the bone mets with high doses for curative intend. Unfortunately his new bone mets cannot be radiated any more. The fields of radiation would overlap.

[6357axbz in reply to GP24]

Thanks, good info. Helps me understand options.

[Break60]

Radiation for specific mets is controversial. You can’t rely on just radiation if you have mets because there are mets which can’t be detected. So ADT continues to be necessary as long as it’s effective. I’ve never had recurrence in mets radiated but new ones popped up when I stopped ADT. There’s a theory that iadt extends the time you’re hormone sensitive and a theory that radiation to oligomets extends survival. No proof yet but it’s worked for me .