My ADT Anniversary. Next steps?

[JPnSD]

My 1 yr anniversary for ADT is next week. Post RP, I got to undetectable (<.01)...and then slowly rose to .16 before I started ADT (Firmagon for 4 months then Orgovyx since) and 4 months after I did Salvage RT (38 sessions ended mid-April). PSA went back to undetectable in the first month of ADT and has stayed there while T bounces from single digits to low twenties, but mostly in the teens (monthly testing for both).

I have seen much impact with all the side effects of Low T during the year, and I REALLY want to take a vacation from ADT to reverse some of these. I am definitely doing the Resistance Training routine....but it can't overcome all the effects of Low T. I see studies saying that intermittent ADT makes little difference from long term. I am thinking of stopping ADT with monthly testing for PSA and T and restarting ADT if the PSA moves out of undetectable. Thoughts?

[StayingOptimistic]

I have the exact situation. My anniversary is on this coming Tuesday and to be honest, I am not sure what to do. I am on a clinical trial for one year which will end on Tuesday. The only difference is I actually want to continue on ADT for at least another 6 months. I am LN and abdomen metastatic by a psma scan. I am not sure what my MO will say on Tuesday but my guess is, he will advice to stop and watch. He is a very experienced MO, so I have decided mentally if he said stop now, I will stop and watch. There is no right or wrong decision, I guess.

[Hidden in reply to StayingOptimistic]

Seems like if you signed up to a trial, you need to abide by the trial protocols and it appears that is what you saying you will do if he so advises.. I assume your protocol is 1 year and others is 2 years. is that basically the trial, or something else? If you kept on with the ADT wouldn't that skew the results of the trial?

[Hidden]

The studies support 2-3years ADT + Zytiga....Why cut the protocol short...if you have a recurrence after 2-3 year of treatment then you know you did everything you could. Cutting it short, you need to accept your decision in the recurrence.

[Tall_Allen]

You are misunderstanding your situation. As a man who has been diagnosed with positive pelvic lymph nodes (N1), you have been treated with what I assume is salvage whole pelvic RT+adjuvant ADT. Adjuvant ADT (which is finite in duration - usually 2-3 years) is a very different thing from the lifelong ADT (from which it is possible to take a vacation). You may be cured if you stay on it continuously for 2-3 years. However, if you stop and restart ADT, you may be selecting for resistant PC (think of stopping and restarting antibiotics before the bacteria are all killed). and you may forfeit all chance of being cured.

[JPnSD in reply to Tall_Allen]

Thanks...that distinction certainly adds a new tilt to things. Year 2...coming up

[StayingOptimistic in reply to JPnSD]

FYI … my doctor stopped the ADT yesterday after being on it for one year firmogon shots.

[JPnSD in reply to StayingOptimistic]

what was your situation?

[StayingOptimistic in reply to JPnSD]

Please see my profile

[JPnSD in reply to StayingOptimistic]

So looks like a 3 year delay in starting ADT, despite RP and RT? I am surprised they would do RT without ADT. It was a requirement for my RT.

[tennis8285 in reply to Tall_Allen]

Thanks Tall_Allen. That is the best explanation/reason I have seen for staying on ADT for the full two years. I have one more shot of Lupron in December which should complete my two year cycle. I was on the fence for stopping it early but glad that I did not.PSA is still undetectable for sixteen straight months. I have another six or seven months left of Keytruda infusions.

[bean1008 in reply to Tall_Allen]

Excellent analogy with the antibiotics, TA. Luckily I’m not one of those experiencing side effects that I can’t live with so have no intention of stopping my Lupron/Zytiga early. And I am comfortable with that regime for the rest of my life if keeps me alive. I don’t understand the thinking of wanting to do intermittent treatment if there is a risk of the cancer returning and being once again detectable.

[Timfc]

I started ADT in March of 2018 in a clinical trial of what is now called Orgovyx. In March of 2019 I was switched to Firmagon for a few months, then to Eligard until April 2020. My last injection was that one, 18 months ago. I asked for a break because the side effects were really wearing me down. I know there are very strong proponents of permanent ADT and maybe, now that I have had a long break, I might just agree with those who don't think the vacations are a good idea. The recovery from side effects, for me at least, has been extremely slow and incomplete. The benefits of this break have not been significant. If or when PSA returns, it is likely that I will agree to be a permanent ADT customer.

[Hidden in reply to Timfc]

most of what I read says it takes as long off of the ADT as was on it to recover. Which menas you have until Spring of next year to start feeling better, no?

[Timfc in reply to Hidden]

It does seem that way.

[JPnSD in reply to Hidden]

My impression is that T return can come back more quickly with Orgovyx (which I am on) when one does discontinue, as it is a daily dose.

[ARIES29]

This is an interesting conversation for me because my ONC is suggesting I take a holiday for 6 months after my next firmagon shot, number 4. PSA now 1.4 down from 18.4 three months ago.Wondering what is the right thing to do?

[Hidden in reply to ARIES29]

TA is discussing ADT for those of us who are newly diagnosed with regional pca at diagnosis ie N1 and confined in proximity of the prostate. The treatment protocol is 2-3 years od ADT and RT +WPRT.

The ADT is not taken until failure but taken for a limited period of time; 2-3 years. Recently zytiga or xtandi have been added and have shown to yield superior results.

[Tally111]

TA, thank you very much for putting it all in perspective so clearly. So two years is a definite for Adjuvant ADT, but how does one decide whether to stop at two years or continue for three?

[JPnSD in reply to Tally111]

Good question. And is the addition of Zytiga or Xtandi indicated if we have already completed a year of ADT alone. What additional side-effect pleasures do those drugs add to the mix?