ADT for AS Patients

[Horse12888]

According to this, the French are giving 3 months of ADT to patients with G6, PSA<10 and on active surveillance, based on a trial with 57 patients in it.

medscape.com/viewarticle/89...

I would no more volunteer for this than I'd cut my right arm off. The entire trial sounds wildly unethical.

Am I right?

[Tall_Allen]

As long as the patients were informed of the potential harms, what is unethical? It was just a single 3-month shot to see if it could extend total time on AS.

[Tall_Allen in reply to Tall_Allen]

I should add that long-term use of a 5-ari (finasteride or dutasteride) has been proven to prevent progression on AS:urotoday.com/journal/prosta...

So you can get a single 3-month shot, or life-long Proscar. Or, there are other options in clinical trials (e.g.,fexapotide triflutate) . Or, with over half of low risk patients never experiencing progression, one doesn't really have to use any adjuvant therapy. I'm glad that there are options.

[Horse12888]

I guess I see your point, but considering that over half of low risk patients never experience progression, 3 months ADT (= almost a year of SEs) this sounds like a rotten deal if there ever were one.

The problem with "informing" the patients are many; in particular, no one knows in advance what the actual SEs will be, what their severity will be, how they will affect the patient's and his wife's lives, when they will go away, and what do to if the T doesn't recover naturally.

I'm trying to imagine my reaction to this, based on my actual experience with 12 months of ADT and ~12 month recovery time.

What if I were told: "Most oncologists don't actually refer to what you have (G3+3=6) as cancer, because the cells in your biopsy look so much like standard, healthy cells. The standard of care is AS, and your cancer will probably never need treatment. But we'd like you to participate in a trial. We're going to inject you with a highly toxic chemical that will chemically castrate you. It will make you, for almost one year, constantly tired, dripping with sweat every half hour 24/7 and thus sleep-deprived, profoundly depressed, impotent, sex drive removed, unable to concentrate, crying every hour or so for no real reason. No one fully understand the mental effects, though patients often describe it as the 'chemical removal of any sense of joy and pleasure.' In fact, you will feel like s*** every moment of your waking life for that period of time; there is not a nanosecond of relief until it's over. And btw, your wife will probably be as miserable as you. But in say, 10 months or so there's an excellent chance you'll feel good again and you can go on with what's left of your life, though there's no actual guarantee of that.

"You may be aware that chemical castration is a form of punishment that we inflict on serial rapists and child molesters, but you should try not to think of it that way. That's why we call this "androgen deprivation **therapy**."

I just can't imagine the look I would have on my face.

[MateoBeach in reply to Horse12888]

Very vivid ( and true) summation,as sad as that is.

[GP24]

The recovery period depends on the duration of the ADT therapy. After three months it will not take a year for testosterone to recover.

In my case side effects of ADT began after two months of ADT, so I think three months is worth the try. You may be able to stay on AS for ten years then. Instead of surgery or radiation which can have significant side effects. The ProtecT trial compared active surveillance with surgery and radiation.

Here is a link to a report about this trial: auajournals.org/doi/full/10...

[MateoBeach]

There is a trial under way for Provenge in AS. Good way to get that on your side earlier where it might do even more benefit.

[Hidden]

Well administering ADT goes beyond active surveillance, doesn't it? It stops being surveillance and starts being treatment.

[j-o-h-n]

No problem Lefty...........

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/24/2020 9:22 PM EST