Hi all,
I know there are so many variables to take into account and everyone is different. But I will ask the silly question anyway - mostly to get feedback on others experiences - how long does ADT really last? Thanks!
How long does ADT really last? - Advanced Prostate...
How long does ADT really last?
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dagreer
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It lasts longer for guys who have successful local treatment, no mets or minimal mets and long PSA doubling times. You could get quite a few years out it and possibly just do it intermittently.
Do you mean, how long until a specific ADT med fails to be effective in retarding cancer progression, and a new ADT med is needed? Or how long until the overall treatment regime of ALL forms of androgen deprivation fails to be effective?
The original ADT was castration, and I think its anti-progression benefits most typically lasted 2-3 years. The castration itself "lasts" forever, of course!
But the earlier that the total load of cancer is reduced, it makes sense that the longer the survival benefit will last. So if we supposed you got an extra seven years of life by being castrated as soon as the cancer was discovered, the longer you delayed ADT then the shorter the cumulative cancer-survival benefit might be. That seems to follow from the exponential nature of cancer growth, but it is still much debated as to whether such a benefit is realized in practice.
Some (like Anthony Horan) have supposed the typical amount of life extension from even a single year-long course of ADT is longer than the typical amount provided by RP. Possible?
For someone in your situation - recurrent and micrometastatic, it is lifelong. There are clinical trials to see if a more intensive hormone therapy early on will give you an extended vacation.
Hi all,
Sorry for not being specific in my question. I meant once I start regular ADT like Lupron or such, and assuming I stay on continuously, how long does it usually past before becoming resistant? I have always heard the number average of 2 years. I know there are a lot of variables but was hoping to hear from folks how long they have been it successfully without becoming resistant. My uncle has been on Lupron intermittently for 15 years. Of course Gleason, mets, etc. all have a big effect on how long it lasts before having to move onto other more aggressive treatments.
In TOAD, among recurrent men with no detected metastases who received immediate ADT, 32% of the men developed castration resistance in the 5 years of follow-up, compared to 42% in the delayed ADT arm. From the date of starting ADT, castration resistance was 70% slower for immediate versus delayed therapy .Global health-related quality of life over the first 2 years was the same for both groups.
In TOAD, most (⅔) of the men getting ADT used intermittent ADT. Maha Hussain's study showed that continuous ADT provided slower time to resistance than intermittent in men with few metastases, so it is plausible that early, continuous ADT may be optimal in micrometastatic men (although this remains to be proven).
A consistent picture is emerging: less ADT leads to faster resistance. Reducing the cancer load as effectively as possible delays castration resistance more than any evolutionary selection pressure it may cause.
Ah - thanks. I like statistics - and those don't sound bad.
TA: Question on "Global health-related quality of life over the first 2 years was the same for both groups." That sounds like people who were on ADT and experienced SEs like fatigue, hot flashes, aches, depression, sexlessness/marital distress, etc. had the same QoL as those who didn't. Can you explain how that's possible?
"Global quality of life was assessed with questions 29 and 30 of the QLQ-C30"
Q29. How would you rate your overall health during the past week?
Q30. How would you rate your overall quality of life during the past week?
Well, I find that remarkable, if not completely unbelievable. I understand that ADT hit me harder than it does many/most, but for the average guy to say that is "overall quality of life during the past week" is unchanged given that profile of SEs is hard to imagine. There are people whose marriages are torn to pieces. That doesn't affect their QoL?
Oh. Wait. I just realized that "during the past week" may invalidate the whole point of the question. Did I feel more rotten in week 42 than I did in week 41? Probably not. If I were asked about my "overall quality of life during the past week as compared to pre-ADT," that would elicit a far different response.
At the risk of sounding immodest, I KNEW there must be something wrong here.
Most of them were using intermittent ADT. It doesn't say it was unchanged. It says that it was no worse compared to men delaying such therapy. Global QOL deteriorates over time whether one is on ADT or not - aging and the cancer itself take a toll.
Oh, I see. Obviously, ADT is a wonder drug for symptomatic men. And people on ADT vacations are actually feeling better as time passes.
People on intermittent ADT deteriorated by about the same amount as people delaying ADT.
I don't understand, except in the case that there are significant symptoms from the cancer itself. You can't mean that chemically castrated men don't feel better when their T recovers. Right?
People on intermittent ADT deteriorated by about the same amount as people delaying ADT.
Well, I would think that this can only come as a result of their advancing cancer and the associated symptoms.
You mention aging, but everyone ages, regardless of which arm of a test he's on.
I find it impossible to believe (having experienced in myself and read hundreds of others' accounts), that men with recovering T don't feel dramatically better.
Am I missing something?
As far as I can see, the only way IADT doesn't increase QoL is if the vacation is so short that it increases the psychological trauma of being whipsawed back into misery after a very short time of feeling good. I try not to think of what I'd be like reporting for that injection knowing how I'd start to feel 4 - 5 weeks later.
Have you worked with guys who experience that anguish?
Don't shoot the messenger - I'm only telling you what they found. The iADT protocol was left up to individual treating physicians. Probably, some used only Casodex. I don't know how long vacations were - they varied - but overall, their self-reported global QOL was about the same in both groups.
OK, thanks. Is there a similar QoL quantification for tE2 vs. LHRL agonists/antagonists? I've read that the former provides an improvement, but I'd be interested to know how much, and, in particular which SEs (other than hot flashes) it ameliorates.
The PATCH trial will directly compare them.
Am I missing something?
No, I don't think so. I think TA is, and namely that is that so-called "objective" questioning on paper forms will never truly answer or objectively measure actual QoL. Each man has a different perception, and a different willingness to reveal what he is feeling, and a different level of need to delude himself into thinking more (or less) positively about how his course of treatment is impacting him.
That "Global quality of life was assessed with questions 29 and 30 of the QLQ-C30" is really just a bad joke, and is as unscientific as supposed "science" can get. There is only one (impossible) way to KNOW the true impact on QoL, and that would be for men to be cloned and have one clone do iADT and one do cADT. Doing "the next best thing" is doing a thing that fails.
The most important lesson of economics is this: value is subjective. You cannot "measure" how much one man likes an apple and how much another man likes an orange and then suppose you can objectively report whether apples are "inferior" or "superior" to oranges. It's nonsensical.
That so-called scientists say they CAN do this is simply an admission that they are not doing science.
Here's what I believe about the study: it includes cohorts that render it useless. If you have metastatic patients in horrific pain, obviously they're going to find ADT a gift from God. Asymptomatic patients, on the other hand, almost to a person, suffer a significant diminution of QoL, and thus feel better as their T recovers.
On top of that, add that "IADT" means dozens of different protocols, according to the triggers to start and end therapy. As I wrote above, people with very short vacations are not going to experience much relief, and may (I would surmise) actually fare worse that those on cADT, because they have to deal with recurring and never-ending experiences of being whipsawed back into misery after short periods of relief.
Yes, well said. These studies pretend to study more or less homogeneous groups when that is not at all what they study.
For them to really be accurate, they would have to sub-group to a degree that would be difficult (and expensive) if not impossible.
I don't think it would be difficult or expensive if there are enough patients so that sub-groups still have statistically valid samples. First, I would back out the symptomatic patients. Then I might group the IADT cohort into groups whose vacations are longer than n months and those with vacations n months or less.
I would bet anything that those with long vacations have far better QoL than those on cADT.
I have a similar feeling about studies that don't show a relationship between ADT and depression. Based on a huge number of stories I've heard, it seems impossible that there isn't causation. It wouldn't be too hard to ask 200 men who had PCa treatment that included ADT as part of their primary treatment, and 200 who didn't, to rate the level of the various symptoms of clinical depression they experienced from 0 - 10.
Of course, it's necessary to word the question such that the patient understands we're not talking about "mood swings," which are extremely common; we're talking about deep, chronic sadness, anxiety, apathy, general discontent, hopelessness, suicidal ideation, and loss of interest or pleasure in activities.
Now, on website like this one, I'm hearing from an audience that is heavily skewed towards adverse reaction to treatments generally; I get that. I still would bet the numbers would be astonishing and the p value infinitesimally small (i.e., lots of certainty to rule out the null hypothesis).
My own went from 0 - 1 to 8 - 9 in a matter of a few months. I would guess that at least 15% - 20% of patients have some dramatic experience like this.
I had a radical prostatectomy in April 2009. PSA 5.8 Gleason 4+4
PSA Started to rise almost immediately after the radical prostatectomy with a doubling time of 85 to 90 days.
Commenced Eligard in April 2011, three monthly.
After a couple of years went to every 28 days. So in answer to your question, my PSA is still undetectable after over 9 years continuous Eligard.
I was 62 years old at diagnosis.
My dad was on it for 15 years ,finally quit working for him, he is stage 4 now, but his cancer is very slow growing at 88 years old . I have been on it for 4 years very aggressive stage 4. It’s still working for me. Not sure there is a guide to tell you. 🙏🙏😡. Fighting the monster
I was diagnosed Gleason eight in late 2012. I immediately went on a Casodex and Lupron regimen with no surgery or radiation indicated as I was metastatic, with two lesions on my pelvic bone.In 2020 I am still on Lupron, but the Casodex was dropped by my new urologist in Florida in 2016. No sign of resistance at this time.
3 years 3 months so far for me. Lupron, 8 cycles chemo and then Xtandi. Extensive bone mets. I figure I will be on Lupron plus something for the foreseeable future. Believe there is a replacement for Lupron coming. We are all waiting for the next best thing.
Are you referring to Relugolix? The FDA recently granted a priority review designation based upon the HERO trial.
Yes, indeed. No trip to hospital for injection. It's been around for awhile. Sure they will find a way to triple the price.
ADT "lasts" over a time between zero months to 20 years.
But if you search for the median time where Psa is kept suppressed below 10.0, you may find an equal number of men get Psa suppressed below 10 for less than say 4 years as the number of men who get Psa suppression more than 4 years.
Having other treatments such as RP, EBRT to PG, chemo, add on drugs like Cosadex, Zytiga Xtandi, Lu177 will make it difficult to measure just how long ADT works.
I got ADT to work well from 2010 to 2016, then Psa went up fast, and the add on drugs added about 14 months more to manipulation of Testosterone.
In old days, having testicles removed was standard practice for men with troubles with their PG in the form BPH which can stop a man being able to pee easily, and often docs didn't know whether a man had BPH only or if Pca had begun, but Pca or BPH causes swollen PG and a man to suffer because he can't pee easily. But the removal of testicles often gave a short tome of relief because the man had cancer, and often first symptoms were blood in urine, and there were mets everywhere, and he died within a couple of years. Some lasted much longer.
In old days, when women got breast cancer, it was often diagnosed way too late; and late diagnosis was extremely common for all cancers so many ppl died before turning 60.
When politicians promised to pay ppl the old age pension in 1908 when ppl turned 65, hardly anyone reached 65, because a wide range of medical troubles or life circumstances made the average age for death of me at about 50.
Its not just cancer that ppl have to survive to live to a ripe old age, its all the other stuff. Many ppl end up getting PTSD just from living life and getting to 70.
Patrick Turner.
I heard once that of all the people in human history who had ever lived to age 65, half of them were then alive in the latter part of the 20th century.
Going on three years. Zytiga,Prednisone, Eligard,Xgeva,Provenge.
Worked for 6 years after prostatectomy and radiation. MO advised that the usual time is about 5 years. Just finished Provenge; next will be adding Xtandi.
Still working after 6.5 years. I was diagnosed 10 years ago, had external beam radiation and went on Lupron 3.5 years later when PSA was more than 2 above nadir.
Braccy in 2005 interrmittent lupron for 7 years ,continuous lupron and casodex until 2017 then zitiga .Still PSA under 1.0 and almost no testostrone ,I'm 88
Prof. Klotz reported in this study that you can stay on ADT without becoming resistant for over 10 years if your testosterone level stays below 20 ng/dl.
connection.asco.org/magazin...
That is really good news. I have to look up his articles.
dagreer,
I provided a link to his study in my post. No need to look anything up. Also, here is a slide from his presentation which shows the result of his findings:
I was diagnosed last year 4+3 and was on Firmagon for 3-months. I heard so many bad stories on Lupron I was scared to death. The only side effect I had from Firmagon was hot flashes, sometimes 12+ times a day, 5-minutes per flash and most people couldn't notice although the flashes did effect my sleep (blanket on, blanket off etc.). I had internal and external radiation after that and amazingly everything still works. Everything. It took about 6-months for the hot flashes to stop and now it's like nothing ever happened. Weird and concerning that my treatment was effective. I'm getting my PSA checked every few months and so far so good. If the cancer comes back - I wouldn't hesitate to go back on Firmagon. Really don't want to do that and I'm enjoying the honeymoon but it was way better than what I expected so far.
Just 3 months only and then you stopped taking it?
Sorry - 4-months. I asked about taking longer and they said it didn't show any difference in the outcome. Additionally, I was told that ADT accounted for only a 5-10% improved outcome (cure - I hope). I subsequently and internal brachy at UCLA followed by 26 external radiation treatments at Hoag.
How long is a piece of string?
Good Luck, GoodHealth and Good Humor.
j-o-h-n Saturday 06/27/2020 6:33 PM DST
Make it into a circle and it goes on.... For-ev-ER (Squints - "The Sandlot")
Not bad but no golden cigar...........
Good Luck, GoodHealth and Good Humor.
j-o-h-n Sunday 06/28/2020 2:13 PM DST
Figures.... since we both see Dr. Morris.... Bon Appetit...
Good Luck, GoodHealth and Good Humor.
j-o-h-n Sunday 06/28/2020 5:44 PM DST
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