medication holiday?

[ABPW]

Medication holiday..? Good morning. My 79 yo dad was diagnosed with prostate cancer 15 months ago, PSA 229 / stage 4 (had Mets in the back) - he has been doing monthly hormone therapy and then daily Zelgor / prednisolone. His PSA levels have been coming down significantly (now at 0.03) and a couple of months ago the doctor took his hormone therapy down to once every 3 months and took Zelgor dosage to 25% and prednisolone to every other day. Unfortunately my dad hasn’t gotten the pickup in energy levels or an escape from the awful side effects of nausea / vomiting etc. even with the lower levels of medications. He is toying with the idea of taking a “medication holiday” for a month to see how he feels physically and how the PSA goes. Not looking for medical advice but just anecdotal info on whether it has helped others (physiologically or psychologically or both). Thank you for any thoughts.

[Shooter1]

I wouldn't stop all meds. Maybe just the Zelgor and see if that helps... At 0.3 he still has some active Pca and you don't want to turn it completely free. Best of luck with dosage and maybe finding a different drug to take Zelgor's place.

[ABPW in reply to Shooter1]

Sorry, PSA is 0.03, not 0.3. Thank you - will consider stopping or reducing Zelgor. Appreciate your input.

[Hidden]

The adt can be torture . Especially the first two years . With a month off I don’t think t will return so fast . But maybe I’m wrong ? Mets in back and 229 Psa is serious . I don’t know any doctor that would suggest stopping adt so quickly with his recent history not good . On the other hand . It’s his life . Good luck . ✌️

[Hidden]

15 months is basically a virgin in treatment . He should go at least a few years undetectable before any breaks . IMO ,I’m not an MO . He might feel better for a minute but then the APC could rage back over him with ferocity . No body wants that . My dad had pc . Had an RP then a yr later died of heart issues at 71 yrs old . I fear an aggressive pc more than being diminished by adt …. We all get that ! ✌️

[ABPW in reply to Hidden]

Thank you… this is helpful perspective. Trying to balance quality of life and ability to keep living your life vs keeping the cancer at bay aggressively. I certainly prefer the latter but it’s really impacting his quality of life and mental state etc.

[Hidden in reply to ABPW]

I can relate to him . I’ve been hammered by adt and no t . It’s a struggle . Take care 🙏

[Foldem]

If your dad is taking prednisone twice a day, take one after breakfast, and the second one at lunch or about 4 hours apart, rather than the second after dinner. The prednisone is a stimulant. This won’t affect the efficiency of the prednisone and was recommended by my palliative doctor to give me some added pep. Best to your dad and your family.

[ABPW in reply to Foldem]

Thank you for the suggestion. He’s taking 5 mg once a day, at the same time as the Zelgor. Interesting idea to tweak time of day, etc.

[Foldem]

He should continue to take his other drug as normal. Just move the prednisone. Good luck!

[Stevecavill]

I'm guessing that the 3 monthly hormone injection is just a larger implant, so the effective daily dose is the same. It doesn't make much sense to take a 1 monthly implant every 3 months.

A one month holiday won't be long enough for testosterone to recover, and to improve the side effects. He would need 3 to 6 months off. and with extensive mets that might not be wise. However, if you track the psa monthly while off ADT it might give him a break.

I've been off ADT for 4 years. I was diagnosed metastatic 9 years ago with mets to spine and pelvis. My psa recently rose to 0.75, and we just radiated two new mets. Will keep careful eye on PSA to see if I need to restart ADT.

[R1166]

I'm just in the process of terminating an ADT holiday that lasted 1 year. It took about 6 months to really feel improvements (and I'm quite young at 56).

Stay strong 🙏