I ended my ADT break in September 2020 when my PSA increased by a factor over 3 in three months. In the next three months my PSA dropped by 41%, followed by 27% during the next three three months and during the last three months it dropped by 40%. In Sept 2020, my PSA was 0.453 and now in June 2021 it is 0.116. On advice of my MO, I have started another break from ADT. If my cancer follows the same path as during the last break, in about nine months my PSA would increase to over 0.500. Of course, prostate cancer be very unpredictable. Otherwise , I wouldn't have ended with metastatic cancer starting from brachytherapy for a Gleason 3 + 3 cancer ten years ago.
I also had chest Xray, CT scan, and bone scan showing no change from last year.
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dac500
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Last time I was on ADT break, my PSA jumped fro 0.135 to 0.453 between the 6th and 9th months. So, ADT was restarted. This time I asked what criteria would be used to restart. He agreed that one of the criterion would be rapid increase in PSA, not the absolute value. I remember, some people in this board suggested that I shouldn't restart until my PSA reaches 4.0. It was a big no-no for me.
During the last break, my quality of life improved marginally. Let us see what happens this time. I am over 80 years. My metastatic cancer load is quite low. All scans are clear. In my judgement, the risk is not high. I will be watching things very carefully. In my estimation I will be back on ADT in six to nine months.
The risk is the risk that the "vacation" will be more of a vacation for your cancer cells than for you. Think of it like starting and stopping an antibiotic if you have a bacterial infection - it selects for the most resistant bacteria. So by starting and stopping ADT, are you selecting the most castration-resistant cancer cells? No way to tell without expensive genomic tests.
Intermittent androgen deprivation therapy (ADT) has been proposed to reduce the adverse events and poor quality of life associated with continuous ADT.
Current data do not show that intermittent ADT is inferior to continuous ADT with statistical certainty.
Quality-of-life measures (including mental health, physical capacity and sexual health) favour intermittent ADT compared with continuous ADT.
In the current era of early systemic therapy for hormone-sensitive disease, intermittent ADT is likely to be best suited to patients with M0 or low-volume M1 disease.
You wrote two contradictory things: "My metastatic cancer load is quite low. " and "All scans are clear. " How do you know you are metastatic if all your scans are clear?
The situation is wrt iADT is different depending on whether you are M0 or M1. Which is it?
The CT scan and bone scan said no new metastasis and lymph nodes have no size changes. They don't confirm that my metastatic cancer is gone. I think I still have low volume M1 disease.
"In patients with metastatic hormone-sensitive prostate cancer, the confidence interval for survival exceeded the upper boundary for noninferiority, suggesting that we cannot rule out a 20% greater risk of death with intermittent therapy than with continuous therapy, but too few events occurred to rule out significant inferiority of intermittent therapy. Intermittent therapy resulted in small improvements in quality of life. "
Translating, this means that:
• there 10% relative increase in the risk of death with intermittent therapy (iADT), compared to continuous ADT (cADT)
• However, the researchers had previously decided that they would not not deem iADT "inferior" unless it was at least 20% worse (with 90% confidence). So i ADT did not meet their arbitrary 20% threshold for calling it significantly worse.
• However, it was up to 23% in some patients within that confidence interval. The confidence interval ranged from 0.99 to 1.23, which means the men on iADT may have died up to 23% sooner or lived up to 1% longer.
Now, for patients like yourself with minimal disease, iADT looks even worse:
• The median survival among patients with minimal disease was 5.4 years in the iADT group, vs 6.9 years in the cADT group - a 19% difference favoring iADT.
• The same statistical arguments apply: The 95% confidence interval ranged from 0.98 to 1.43, which means the men on iADT may have died up to 43% sooner or lived up to 2% longer. Although this is "statistically inconclusive," it doesn't bode well for iADT.
As for quality of life, they found that iADT was associated with improved erectile function and mental health at 3 months but not thereafter. "There were no significant differences between the groups in the number of treatment-related high-grade adverse events."
Thanks for the information. During my last break (Nov 2019 to September 2020) my PSA as at 3 month:0.07, at 6 month: 0.131, and at 9 month 0.453. That triggered start of ADT again. If it is repeated, I will restart.
When I was diagnosed with lymph node metastatic cancer, I was initially on Lupron and Casodex for one year. Then I had a nine month break. The break ended when my PSA increased by a factor over three during three month period with my T between 114 and 147. Then I was on Eligard (Lupron shortage) for nine months. If quality of life is not a major concern concern, do you think I should be on continuous ADT when restarted? My T was between 322 and 300 before start of ADT in 2018.
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