Three months after my radical prostatectomy, I had a PSA of 0.22 and three months later, 0.21. My oncologist then started me on an 18-month Eligard treatment. After the 4th of 3-month injections (my PSA had dropped to zero) the oncologist said that I didn't need any more. That was in December (I was due for number 5 last month).
I'm wondering if this was the right thing to do and if not, can I just continue with the other two or will I need to begin an 18-month treatment?
Didn't you also have salvage radiation?
Yes, I received 'postoperative salvage radiation with a stereotactic approach to 30 Gy in 5 fractions', ending in early August.
ADT doesn't have any extra benefit when used with salvage radiation when your PSA is below 0.7. There may be even less need for adding ADT when SBRT is used. So, it's time to stop all treatments now - you may be cured! Just monitor PSA and testosterone levels every 3 months.
Thanks for all you do Allen. I will push them for those tests.
Tall Allen, do you have supporting documentation for not using ADT after salvage radiation? I had a prostatectomy and rising PSA, did IMRT in May of 2020 have been on Eligard/Lupron, Zytiga Prednisone. Since November 2019. My PSA was 0.25 three months ago and 0.26 last week. Should I talk to my Med- Onc about getting off everything? Thanks for your help. Niels
TA didn't say not to us ADT after SRT...SRT + ADT with psa at .7 is what he was referring too.
There is no such documentation - it's very much the opposite. I very much think you should stay on Zytiga+ADT until it stops working and then use docetaxel.
Thanks for the clarification, I am not having major issues with the current treatment, I am planning on going at least until November 2021, then take a look at a vacation?
You have metastatic PCa. If you are "not having major issues with the current treatment," there is no reason to have a "vacation."
Thanks I appreciate all your help.
If your MO/RO hasn't explained this to you then you need to discuss what PSA means for someone who had a RP.
You need to be at undetectable, ie < 0.1 on a psa test for at least 12 months and many, including myself, believe 18+months
With a psa of .26 you have cancer that may be castrate resistant which means it grows even in ultra low T conditions.
Unfortunately, you will need to be on continuous ADT.
Thanks, i assumed as much.
Yes. Your Doctor is right. Just monitor PSA and if there is increase, you can always go back on Eligard.
That's true - thanks for responding LearnAll.
If a drug is working why stop it? I am not a fan of stopping and starting treatments. It gives the cancer a chance of producing a new line that is resistant to the drug. I would question your doctor on this.
I have a call in on Tuesday and after reading the responses I'll leave things the way they are. Thanks for your response Magnus.
To add to the conflicting advice and opinion, some would suggest the longer you are on ADT then the greater the likelihood you are pushing any remaining cancer cells into selective pressure towards eventual castrate resistance.
While studies may or may not give evidence of this, it seems quite possible intuitively. Yes, there is also intuitive logic in "keep on doing what is working" but I tend to believe iADT (of at least a year "on" therapy) may be as good as cADT for many men, and potentially better in terms of both QoL and time to castrate resistance. I am just starting ADT and if my MO suggests vaca at one year I will be delighted. (He won't suggest it, but I will probably do it anyway.)
It's not like 18 mos vs 12 mos assures you of anything definite, anyway, so far as a potential future need to return to ADT.
That's the great thing about the people on this site - all providing heartfelt responses. I must admit I was thrilled to be told I was off the ADT but wondered if it was the right tactic. Thanks for taking the trouble to reply noahware and I hope things go well with your ADT.
I'm more like an elderly fart nowadays but physical activity is so important. Thanks for your thoughtful response Nalakrats. I'm curious if my T is starting to recover. I'm still getting hot flashes but don't burst into tears as often! Good point about monitoring the PSA more often.
Eligard - delay by 1-2 months?
Lupron - 18 months vs 24 months
Returning ADT after holiday for 9 months.
PSA rising after 18 months
Going wrong way after only 6 months
