My husband was diagnosed 6 months ago with stage 4- Gleason index 9, metastesized to spine and lymph nodes-low burden. Taking monthly Firmagon, Zytiga, Prednisone and Metformin. Alternative doc recommended taking a vacation from ADT, monitor PSA, Testosterone and resume when PSA is about 30. That is where it was when he was diagnosed. Now PSA undetectable. Alternative doc recommending intermittent ADT for reason that cancer is less likely to become resistant to treatment. Has anyone had success with this and what was the recommended PSA to resume treatment? Has anyone been able to get off ADT after an initial treatment when PSA became undetectable and just stay on Metformin and other supplements?
Has/Is anyone participated/participating in past or current prostate cancer bipolar therapy with testosterone where high levels of testosterone injection is received while on ADT. Thank you for any help.
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Lavabeach
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I cannot comment on the use of testosterone injections - someone here can comment. I believe it is very experimental, does not have the backing of credible studies yet to validate it is a good alternative, etc... but I’m no expert.
I am concerned about your “alternative doctor” advice. To come off of ADT at this point, in my opinion, is incredibly irresponsible medical advice. Your husband is stage 4, with a very aggressive Gleason score. The reason he is undetectable now is the ADT treatment he is receiving.
Not sure from your description of the mets if your husband is considered “oligometastatic” - meaning having 5 mets or less. That’s how I am characterized (I had 1 in the spine, original PSA was 227, Gleason 8). After ADT for 4 1/2 years, Zytiga for 2 years, radiation to the spine and a prostatectomy, and being undetectable for the second time for almost 2 years, I am “negotiating” with my MO to take a holiday. They want me to wait 3 years post being undetectable. (I go to MD Anderson). So, if he is diagnosed as oligometastatic, there are some aggressive approaches being tried. But they also lack validation.
Please make sure you are under the care of a medical oncologist who specializes in prostate cancer - preferably at a center of excellence hospital. There is a lot changing right now with PCa (lots of advancements), but personally I have sought after the best advice I can find from the most knowledgeable people. Believe me - I know how hard being on ADT is - it is really tough. But it is also the reason most of us here are still with our loved ones. With proper diet and exercise, it’s at least manageable. in. (By the way - I’ve had these same conversations with my oncologists, too, trying to find some quality of life relief. I’m relaying what they told me. We all want the treatment to be more bearable...)
I hope this point of view is helpful. I’m sure others more knowledgeable than myself will also weigh
Best wishes on the journey. We are praying for you both!
The Hussain randomized clinical trial found the opposite to be true - in men with low metastatic burden, men lived longer if they had continuous ADT rather than intermittent ADT. Intermittent does not increase the time to castration resistance (although adding Zytiga does). Here is the study, if you want to send him the link:
"The median survival after randomization among patients with minimal disease was 5.4 years in the intermittent-therapy group, as compared with 6.9 years in the continuous-therapy group (hazard ratio for death with intermittent therapy, 1.19; 95% CI, 0.98 to 1.43)."
However, that study was before Zytiga, so it is entirely possible that intermittent Zytiga + ADT is not inferior to continuous.
Here is some info on BAT for mHSPC. You will notice that sample sizes are very small because it is exploratory. We need to learn in which men it is beneficial and in which men it is detrimental:
Do you mean the opposite (increase instead of decrease)? " Intermittent does not decrease the time to castration resistance (although adding Zytiga does)"?
They say Median survival was 5.8 years in the continuous-therapy groufp and 5.1 years in the intermittent-therapy group And their intermittent was only after 7 months on. Scholz and dr turner and ucla Recommended 18 to 24 months on Zytega and adt before a vacation. I did 21 months. Could be a mistake. We shall see.
I was quoting survival numbers for the subset with "low metastatic burden" which is what the OP has. Everyone has their own way of doing "intermittent," and there is no data that tells us one protocol is better than another.
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