2 years of ADT counting from end of IMRT versus first injection 6 months before?

[B8ssist]

To be clearer than my title of this question, my Urologist told me that he counts the 2 years of Eligard to start after my IMRT finished( August 2020) instead of March 2020 when I received my first injection. I was trying to process it and forgot to ask for further details. BTW, my PSA remains low at 0.0. And to further clarify since I haven’t posted in awhile, I had 1 positive lymph node up on the bladder and 6 weeks post prostatectomy my PSA was 0.41 prompting the IMRT.

[Magnus1964]

Congratulations, your doing well. So why change anything? If eligard is working why the 2 year limit.

[maley2711 in reply to Magnus1964]

I f the PSA is zero already, is there proof that continued ADT prolongs life?? there does seem to be clear proof that absence of ADT provides more QOL !!

[Magnus1964 in reply to maley2711]

Are you having bad side effects from Eligard? If so, you could ask your doctor to switch you to another ADT drug. Maybe start on a milder drug like casodex.

[maley2711 in reply to Magnus1964]

No, I'm at the point of deciding on surgery or radiation +18mo ADT for my G 4+5..definitely severe fear of ADT! Isked my questions " I f the PSA is zero already, is there proof that continued ADT prolongs life?? there does seem to be clear proof that absence of ADT provides more QOL !! " because it seems you have been involved with ADT for many years, and I think many here besides myself would like to have the benefit of your research ?

[B8ssist in reply to Magnus1964]

Magnus 1964, I get hot flashes and have some peripheral neuropathy in the sensation that my feet are burning. I started on Effexor so will wee if that helps.

[Magnus1964 in reply to B8ssist]

I have peripheral neuropathy also. I take gabapentin and Tylenol. This works quite well for me. As to the hot flashes and other side effects of ADT drugs, I don't know of any way to avoid them. These symptoms do fade away with time. I used to take a soy supplement that reduced the hot flashes years ago. But since then some members of this forum say soy is bad for prostate cancer. I never had any problems and that was a long time ago. From my research there is a chance that soy consumption can increase the risk of prostate cancer. But since we already have it, what is the risk?

[GP24]

The two years count from the end of your radiation. But a new phase III study showed that 18 months is enough.

[Don_1213 in reply to GP24]

The study actually was for a total ADT treatment. 18 months since the start of ADT was found to not be inferior to 24 months of ADT for high-risk PCA patients who were using IMRT as their primary treatment.

IMHO - his urologist is flying on ignorance (of the newer studies) or by the seat of his pants. I'd suggest consulting a medical oncologist specializing in PCa (who is likely to be more up to date on current standards) or even the radiation oncologist who did the IMRT.

In my case - I pointed all 3 of them at the Nagar study (the medical oncologist was familiar with it) and all 3 agreed 18 months from the START of ADT was adequate. (G9/10, PSA 3.4, 45 IG/IMRT, 83 Gy, 18 months of Lupron, finished in June 2020. Currently undetectable.)

The theory of why not just do it longer ignores the comorbidities that ADT brings along with it - in particular the cardio issues. The numbers of cardio related deaths by ADT patients is really rather scary IMHO. Death as a side-effect of treatment is never desireable.

[GP24 in reply to Don_1213]

Yes, many doctors ignore the side effects of ADT. On the other hand, a few strictly refuse ADT when they get diagnosed with PCa. I usually refer to the study as the Nabid study:

pubmed.ncbi.nlm.nih.gov/299...

[Don_1213 in reply to GP24]

I thought "Nagar" perhaps was wrong.. didn't go check the paper I have saved. Many doctors along with ignoring the really serious side-effects of ADT also don't inform the patients of the potential side-effects, meaning the patient is making an uninformed health judgment... something I find really offensive.

[B8ssist in reply to Don_1213]

I read the study. Definitely something to bring up to my Urologist. I am going to email him and ask his reasoning behind 2 years from the end of radiation versus 18 months and Even from the start of my first injection of ADT.

[Tall_Allen in reply to B8ssist]

B8SSIST - You appear to be listening to misinformation, well-meant, I'm sure. Your circumstances are completely different - your PC is N1. 18 months is NOT enough.

[Tall_Allen in reply to GP24]

No it didn't. That trial was NOT for men with N1

[GP24 in reply to Tall_Allen]

On the other hand, B8ssist had salvage radiation. In this case the following study shows six months of ADT works well.

thelancet.com/journals/lano...

Therefore I would see no problem terminating ADT after 18 months when there is just one affected lymph node.

[Tall_Allen in reply to GP24]

No, no,no, Salvage radiation when there is N1 requires 2-3 years of adjuvant ADT with it. You are misunderstanding his situation. That reference screened out men who were N1.

[Tall_Allen]

2-3 years is about right.

[Purple-Bike in reply to Tall_Allen]

The study refers to high-risk localized PC, not metastatic PC. Maybe 6 - 18 months more when there have been (zapped) mets, which makes for the total of 2-3 years that TA refers to? Particularly if side effects can be reduced by intensive weight training and transdermal estrogen.

[B8ssist in reply to Tall_Allen]

Tall_ Allen, Thank you. I am going to keep following my Urologist’s plan for me at this time. When I do come off ADT, then we will see if I need to seek further treatment or not. I trust your judgement. There are always a lot of trials going on and it is easy to get lost in the sea of information that is found. At some point I also have to have faith in my Urologist that he knows what he is doing. I specifically picked him out of the group he is because of his background in pCa.

[Hidden in reply to B8ssist]

It sounds like your uro is a good one. Being in the med field I’m sure that you choose well! Keep rocking and rolling amigo.. ride on 🏍

[Hidden]

Maybe the xtra six months over 18 will nail that pc’s dreaded ass to the floor ?? I hear what you’re saying . I’ve been on adt over six years . It ain’t no disco it ain’t no party either ,but no signs of Psa you can do for many years !

[Hidden]

B8, I am from SA and live in Houston. I read that you are 61; I was 55 when PCa was dx’d by my Urologist. The biggest decision you have is just who is managing your cancer. I am not a physician and do not know about any existing co-morbidity issues. Your decision based on research and referrals. I can only share my path. I know that you want the best specialist available.

In 2003, RP and Brachytherapy had similar success rates. I opted for a Radiation Oncologist for Brachytherapy in SA; as he had done over 2500 procedures. He suggested in the initial plan to add 25 sessions of IMRT. His referral was a close friend in Houston who was a Professor and Researcher at Baylor College of Medicine and Chief of Radiation Oncology at Methodist.

When my PSA rose to 32.4 in 2004, and scans revealed mets, he referred me to a Medical Oncologist also a Professor and Researcher at Baylor. I underwent a six month chemo with hormone trial. When this specialist moved to Memorial Hermann and UT Medical School, I also followed. In other words, I found my guys in academia and research.

BTW, I was able to stop Lupron/Eligard in 2010 at the insistence of my Medical Oncologist. My whole point is to find the best damn specialist available, someone who is on top of their game, and follow their instructions. Don’t fret about when you can stop hormone therapy, but rather, should you stop; based on your pro’s treatment plan. There are excellent pros in SA as well as within the Texas Medical Center in Houston. Good luck. PS. Two months before PCa was dx’d, I had a double by-pass. Listen to your pro. Almost all side effects are manageable. If you are concerned about those who worry about ADT and cardio issues, seek out a great Cardiologist and let them work with your Oncologist it manage your health.

Gourd Dancer

[TJGuy]

I was put on 24 months of ADT from beginning of ADT which was a little over three months before start of PBLN IMRT Salvage Radiation.

I came off ADT about six weeks ago in July 2021. Two years from end of radiation would have been early December.

Will have first PSA and testosterone tests next week.

Still having hot flashes.

I began ADT after PSMA, Choline, and MRI scan came to similar results. Several pelvic Lymph nodes.

PSA has been <.01. Testosterone varying but ended at 15, so always under 20.

Choline scan to follow end of October.

[B8ssist in reply to TJGuy]

That is excellent.

[Hidden]

I'm in a similar situation as you...RP followed by ADT then IMRT. My last Eligard shot was July 14th so I will have been on ADT for 27 continuous months. I was also on Abirateron Acettate (Zytiga) 20 months. I was allowed to stop the Zytiga when I get my last Eligard Injections. My post RP pathology was pT3bN1M0 with G9 (4+5). 1 node positive and I am sure there were probably many more.