When should your Dr put you back on some form of ADT?
I was on off lupron for about a year, then my PSA started to rise, .19 -- .28 --- .48 and then jumped to 2.00!
My PSA doubling time was 6 months or less.
He just recently placed me back on lupron but mets already showed up on a scan.
Thanks..
My doc says when PSA gets back to 2. Did you have mets previously?
thanks - no previous mets but do now in the liver..... i thought asap when you have detectable psa.
In this trial they restarted ADT at a PSA value of 10. "Provided there was no intervening evidence of disease progression" which is the case with you since new mets showed up.
"When should your Dr put you back on some form of ADT?"
The question should be, when should your doctor try intermittent ADT (IADT)?
I've been gung-ho with wanting IADT, since responded amazingly to treatment, Dx'ed PSA 1000+, 11 months ago, extensive pelvic and vertebral metastasis. The ADT, Lupron and Zytiga has me currently at PSA <0.02.
My oncologist stated, strong evidence that I have "hormone sensitive" prostate tumor at the moment. So why tempt the devil, in just 11 months...
Yeah, you are doing great and perhaps have no pain? Why tempt the Lupron gods? I asked my Doc the same Q. With multiple mets and Gleason 9 he didn't think it was a good idea.
Only had pain, burning urination when Dx'ed. The pain went away in less than a week with Bicalutamide.
Where are your multiple mets? Are you having radiation?
Had RP in 2017. Multiple mets found after so radiation canceled. Mets in C3, right scapula, multiple ribs. Lupron, Zytiga+pred & Xgeva since 12/17. <0.01 ever since.
My doctor said maybe we could talk about a vacation after two years
Was on intermediate ADT (Lupron) for a little over 6 years dropping the PSA to zero then riding along watching PSA values till they got to around 4. When Lupron no longer dropped values to zero we stay on Lupron all the time plus Xtandi. PSA now nil again.
I went back on around 2.0 but had radiation as well. See my profile.
ADT for me is life long, why rock the boat as long as psa stays low, my oncologist will not take me off lupron and will not add othrr things until over 3 or 4, at 1.9.
I believe that others have pointed the way - MY understanding is once the PSA goes past 2, it is time to take a close(r) look. Although I have seen numbers between 4 and 10 as the trigger to restart treatment, once you get a doubling time that occurs relatively quickly, it is time to intervene with another cycle or stage of treatment.
Hopefully, seeing as you have been well monitored, the intervention is happening on a timely basis.
We wish you well on your journey ....
Our doctor set the ADT restart number at PSA of 1, but this is because my husband's initial PSA seemed low for his disease burden. It was 5 after RP with a met to the sacrum, many lymph nodes and 2 mets in the left lung. He currently has a PSA of 0.051 with 1 year off ADT/zytiga.
Based on my response to six cycles of taxotere, 25 radiation treatments and 18 months of Lupron my medical team and I agreed to stop at 18 months vice 24.
That decision was a result of my PSA and T dropping to <.1 and 7 within the first two cycles of taxotere and the initial 90 day Lupron shot. They stayed there the entire time. Last Lupron was May 18
Since then labs are
August <.1, T <7
October <.1, T135
February
.36, T482
.24
April.05
June .12
August .06
I feel great!
We won’t let the PSA go above 4 before starting treatment again. We’ll image using the Axumin scan around 2.
I don’t know what the treatment will be when we start back up. Most likely combination therapy.
I think they key is have an active monitoring plan when you go off treatment and decision points and criteria to go back on treatment and with what based on newer imagining and other clinical data such as GS, doubling and velocity...
Kevin
Lupron Lifer.
I having been living with metastasized (bones) prostate cancer (Gleason 8) for 8.5 years. Right from the beginning I did intermittent ADT, against my doctors wishes. When my PSA bottomed, usually under 1.0, I would go off ADT until I experienced a symptom, which was bone pain. In one case my PSA got as high as 498. I really enjoyed that vacations as I treasure quality of life. ADT became less effective by itself about two years ago. I haven't add a vacation since :-(. I added Xtandi which became less effective last October and with a current PSA of 110, I replaced Xtandi with Zytiga just last month. I'm very active and still enjoy each day 
Lupron vacation. Include casodex?
drug vacation 
PSA rising after Lupron "vacation."
