Hi all, I don't post a lot but am hoping for some input on WHEN to stop ADT+Zytiga. I'm finishing 12 months soon and trying to decide whether to go on to 18. Like many of us, my case is a bit unusual - here are the essentials:
-Diagnosed 52yo, GS 4+3, PSA 11 and then 16 after biopsy. Clean CT scans and clean PSMA PET in advance of RALP @ Stanford. P2CN0 after surgery - no margins, 0/15 lymph nodes....but persistent PSA at 4.0 after surgery. Axumin scan identified 2 avid lymph nodes, and second reading of PSMA PET seemed to confirm the same. Started Lupron+Zytiga and completed 72gy of EBRT in January. PSA has been undetectable at <.05 ever since.
Given the good results of EBRT + ADT, it might seem reasonable to continue with 18 months of ADT+Zytiga. On the other hand, a second opinion at UCSF mildly suggested that only 6 months ADT + the adjuvant EBRT might be sufficient.
Side effects haven't been too bad...but as expected I'm losing muscle tone, feeling fatigued, and feeling beaten down. In short, I'd really like to finish the ADT+Z and see what happens, but hate to make a bad decision given how awful this beast can be.
I'll be seeing my MO again in a few weeks and expect that she'll vote the full 18 months. Still, I've seen a newer 2019 study suggesting benefits of longer duration ADT are based mainly on the number of risk factors one has after primary surgery (ncbi.nlm.nih.gov/pubmed/307...). I only had 1 risk factor after primary treatment (PSA>0.5), whereas benefits were best for those with more than 1 risk factor (the other two factors were pT stage ≥pT3b and pathologic Gleason ≥8.)
Thank you in advance for any ideas or input!