Question on Intermittent ADT

[davebliz]

I was diagnosed Apr/19, Gleason 4/4, on lymph nodes. Started Zoladex in Jun/19, 37 treatments of radiation in Nov/Dec. PSA is 0.08. They want to put me on intermittent Zoladex. I'm a bit concerned it's too early to start that, thinking I should be on Zoladex for minimum of 2 years before starting on and off. Anyone with similar experience, thoughts? Thanks.

[Tall_Allen]

I agree with you. In two separate randomized trials, 18 or 28 months of continuous ADT after radiation had superior results in high-risk men. However, none of the men in those trials had positive lymph nodes, so 2-3 years is probably safer in your case, if the side effects are tolerable.

I don't think that intermittent ADT is at all appropriate for men receiving ADT adjuvant to radiation (where the goal is curative). Intermittent ADT has only been tested in the salvage situation (when the patient will be getting life-long ADT)

[davebliz in reply to Tall_Allen]

Thanks for your quick reply. Would you happen to have links to those two trials?

[Tall_Allen in reply to davebliz]

Sure:

thelancet.com/journals/lano...

europeanurology.com/article...

[davebliz in reply to Tall_Allen]

Hi Tall_Allen, thanks for the links. I've read over both of them and unless I'm wrong, they don't really answer my questions. The first one compared 4 months of ADT versus 28 months and said 28 months was better. In the second one, it concluded that 18 months ADT was as beneficial as 36 months of ADT and patients had better QOL. Regarding the goal in my case, I don't think it's curative as the cancer has spread to the lymph nodes. My urologist is consulting with the radiation oncologist regarding going on intermittent.

[Tall_Allen in reply to davebliz]

Then I don't understand your question. Didn't you want to know how much adjuvant ADT is necessary? That is your answer.

Why is it that you don't think it can be cured if it has only spread to your pelvic lymph nodes. Didn't they irradiate your pelvic LNs? Talk to an RO not a urologist.

[Magnus1964]

I think it is way too soon to start intermittent Zoladex. Has your doctor explained why he wants to start intermittent treatment? If not you need to question him/her.

[tango65]

At least 18 months

ncbi.nlm.nih.gov/pubmed/299...

Best of luck.

[Hidden]

Dave, I do not mean to be negative not non-supportive, however, I question an Urologist, and I don’t know anything about him; only that most Urologists are surgeons. Consulting with a Radiation Oncologist?

As soon as I was diagnosed with a Gleason 7, I went straight to a Radiation Oncologist to develop a treatment plan. A year later when primary treatment failed, both of the RO’s referred me to a Medical Oncologist. In this case since on of the ROs was in academia, I was referred to a MO in academia and prostate and kidney cancer research. That was in 2004.

I suggest you get yourself to a Radiation Oncologist or a Medical Oncologist that specializes in PCa. A Gleason 8 is nothing to jack around with.

Keep kicking the little bastards.

Gourd Dancer

[davebliz]

Thanks all for your comments. A few clarifications. I'm in Canada and my cancer team consists of Urologist, RO and MO. The MO is basically out of the picture for now as I don't have any metastasis to bones or organs. The Urologist has suggested I go to intermittent ADT but is going to consult with the RO. Tall_Allen, yes you are correct and phrased my question much better. I am most curious with your comment on being cured. I thought that if the cancer had exited the prostate, there was no cure, just managing the cancer. And yes, they did irradiate my pelvic LNs.