I would be most grateful for your opinion on my present situation. Since September 2019 I have been on my 4th ADT of Lupron and Cassodex. Cassodex only for 2 weeks. My PSA was 3.70 but the doubling was every FIVE weeks. On this fourth ADT, my PSA has NOT GONE to undetectible. As of last week it is 0.07 and testerone is 0.04.
IYO is it OK for me to take a break from ADT?
I am concerned due to the 5 week doubling between the 3rd and 4th ADT treatments.
OR should I be on CONTINUOUS ADT because of my doubling speed and that my PSA has NOT GONE to undetectible.
Thank you sincere for your opinions and guidance.
Chris
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Christopherg
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If it were I ? I’d stay on continuous adt further .. Hello Chris . .07 is undetectable Sir. Congrats but I think you should stay undetectable for longer before a break. I’m not a dr. I’ve been on constant adt over five years with no one talking about a break for me . No one wants to rock the boat .. I’ll watch to what others answer you ? I say don’t worry you’ve got great results. Adt is needed by most of us . It’s not a nice change for any of us . I fear the APC gobbling me up more that the adt . And I’ve been hit hard by its extended use and no t .
Hi Whimpy, My reason is that I have no energy and am fatigued all the time. But concern that I am not undetectible. All best wishes to you and thank you for your time in replying to me. Chris
With multiple distant lymph nodes, it doesn't seem to make much of a difference if you opt for intermittent or continuous ADT. I don't know how much of a break you will get - it depends on how quickly your T comes back.
There are a couple of experimental options that you can discuss with your oncologist:
(1) BAT -you might be able to get it per protocol from Sam Denmeade (Johns Hopkins), Oliver Sartor (Tulane) or Michael Schweizer (SCCA):
(2) Adding an advanced hormonal agent (e.g., Zytiga or Erleada) in a clinical trial. Sometimes hitting it extra hard during the on-cycle will enable a longer vacation:
I have said on this forum Many times I am not a fan of intermittent ADT treatment. If a drug is working then stay with it. Using intermittent ttreatment can give the new cell lines a chance to find a work-around.
Your PSA is still low. So stay with the Lupron and casodex.
Thank you Magnus. I am grateful for your opinion as difficult as I find it. Good health to you and all best wishes, Chris.
Your PSA is undetectable. Anything less than 0.1 is considered undetectable. You haven't been on Lupron long enough to take a break, continue on with Lupron and Casodex. Don't try to fix something that isn't broke.
It sounds like you have been doing Intermittent ADT already by taking breaks from Lupron and Casodex.
There are some basic principles when someone opts for intermittent ADT. First ..they should be able to reach their lowest point (nadir) then, they need to have their Upper set point where ADT is RE-Started marking the end of Off Period.
Your data is somewhat confusing.
What was your upper set point for restart in your last 3 ADT cycles. And what was your lowest set point to stop ADT in last 3 cycles? Both Set points must be clearly defined and rigidly adhered to when doing Intermittent.
Bottomline: You need to stay on ADT as long as your PSA does not touch the lower set point you used in your last 3 cycles. PSA and ALP needs to be closely monitored esp during Off cycle.
Note: I am on Intermittent ADT (prostate 100% intact) My predetermined lower set point is 0.2 and upper set point is 4.0 or 10.0 (only if absolutely no symptoms) This is from Nicolas Mottet et al ....Randomized 58 center famous European Study (Yr 2012) which concluded Intermittent as non inferior to Continuous and having potential to delay castration resistance.
It is well established that with each ADT cycle..the Off period keeps getting shorter and shorter ..as androgen independent cell population does increase...albeit with slower speed then Continuous ADT. Eventually ..all of us become castration resistant..its only a matter of time.
Hi LearnAll, I have had 3 intermettent ADT treatments over the past 9 years. Each one was 9 months. I have always had fast doubling to I would have to restart ADT when my PSA was bettween 3.4 to about 6.
The past 3 my PSA dropped very quickly after starting, a matter of a few weeks.
This is now my 4th adt treatment and I am on Lupron only, no Cassodex. So in about 11 months the PSA has not gone to undetectible like the previoius 3 adt treatments.
This is the longest I have been on Lupron.
In retrospect probably I should have been on adt LONGER than the 9 months. But my MO said it is OK to come off adt as I had been undetectible for about 8 months on each cycle.
My MO is OK with me taking a break but with a five week doubling speed I am quite worried it will roar back after probably a few weeks.
IF INTERMETTENT CAN DELAY CASTRATE RESISTANCE, MAYBE I SHOULD TAKE THE CHANCE AND STOP ADT.
I can always go back on depending on what the DOUBLING speed is.
I have read that staying on ADT for 18 months may be a benefit. I dont know as there are so many opinions that it gets confusing.
I am seeing my MO tomorrow and maybe I should be adding a 2nd generation drug to bring the PSA to undetectible.
Congratulations! 9 years on Intermittent ADT is in itself an achievement. Your MO is right that you should continue with Intermittent ADT as long as possible. Eventually almost all cancer cells will become androgen resistant but the goal should be to delay as long as you can delay the inevitable. I have read in some studies that if Luprolide alone can not take you to your lower set point ,you should add a lutamide or Abiraterone to accomplish that point. And once you achieve your lower set point (undetectable) then you stop both meds and declare start of your 4th OFF period. The researcher call it Combined intermittent ADT.
It all makes sense if you understand that with each ADT cycle some more cancer cells become androgen resistant and therefore it get harder to achieve low set point in later cycles.
Also, Off period gets shorter and shorter with each cycle due to the same reason. If I were you ..I will ask my MO to add a second generation med to lupron and this way I will be able to achieve my low set point and then re-start next off period.
Many thanks for your advise. I did get the Lupron shot today so I am 'set' for the next 3 months. My MO doesnt want to add the 2nd generation drug yet. So fingers crossed the PSA will come down a bit more (I can but hope). I do a blood test in 6 weeks and if it hasnt moved, will ask for a 2nd generation. The sooner I can get a holiday will be better as you say. Thank you so much for sharing your opinion and experience. I am very grateful.
Great ! The goal is achieve the low set point whatever way you achieve it. If Lupron can do it that's great. Wish you success in your intermittent ADT adventure.
You could consider finding a place abroad which accepts castration sensitive patients for lu 177 PSMA treatment and see if Lu 177 PSMA treatment helps to control the metastases.
Why are you entertaining this? Side effects? Money? Do you have to take a break or just want to?!!
I’m on a break because of horrendous side effects, most of which have gone but and I’m not sure if the anxiety of waiting the other shoe to drop in lieu of the missing side effects is worth it!!!! It gets into your (whats left of my) mind and won’t let go!! Kind of takes all the fun out of your life!!!
Are you saying that you have had four cycles of IADT in less than a year? Or are you saying that you have had four ADT shots in the last year? If your PSA is spiking between 3-month Lupron shots then I would have to ask whether it is sufficiently suppressing your testosterone and a different drug is in order.
I started off with IADT and each treatment cycle was 6 months or more, ending when PSA was undetectable (<0.01) AND resolution of mets was confirmed by scans. That seems difficult to accomplish 4 times in a year.
The 2012 Juanita Crook, et. al., paper studying IADT used an 8-month treatment cycle and going to an "off" cycle only if there was no evidence of disease and PSA < 4 ng/ml. (I would not have felt comfortable stopping ADT unless PSA was undetectable).
Thank you Ronny, you are probably correct in the conclusion. I am meeting my MO tomorrow and will discuss adding a 2nd generation drug. I think it is time.
How much does age play into the calculation? Have hear that those 80 yrs+ and in otherwise decent health but having very difficult time with ADT side effects, are better off to take a holiday? Any thoughts on that?
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