ADT vacation

[tennis8285]

I am somewhat confused as when to take action when on ADT vacation. To set the stage, I am on Lupron and Keytruda and psa has been undetectable for 17 months. Initial scans showed lymph nodes and bladder neck invaded with pc two months after prostatectomy done two years ago. Gleason score of 10.

I plan to have my last Lupron shot next week (completes two year treatment), but Keytruda to continue till April, 2022. First of all, after treatment stops, how often should I get psa checked? Three months seems like a long time with Gleason score of 10. Also, should I be getting the super sensitive psa test which I assume goes to three decimal points? Based on some previous posts, it seems that no action is warranted until psa rises to a certain point (0.2). Is that correct or is the rate of rise also relevant? Although there will be not be an absolute correct answer, how much of a gamble is it for me to take an ADT vacation? By then, I should have (hopefully) psa undetectable for 22 months.

[LearnAll]

I am a big fan of intermittent ADT and/or ADT vacation. But after reading details of your profile and noting that your Gleason grade is 10, I would suggest not to go for ADT vacation or if you really want to do it, monitor your biomarkers such as PSA, PAP, Bone ALP at least 2 times a month. You are not a very suitable candidate for intermittent ADT.

[Magnus1964]

I am not a fan of ADT vacations. If something is working, stay with it. At least stay with the Lupron and have your PSA checked every three months. Congrats on undetectable PSA for that long.

[Tall_Allen]

Are you positive for msi-hi/dmmr?

[tennis8285 in reply to Tall_Allen]

Yes, msi-hi.Tall_Allen, I’m sorry to post this question twice. But I did want to make sure you saw it and I got your opinion.

[Tall_Allen in reply to tennis8285]

No problem- I answered in the other place.

[daniellt in reply to Tall_Allen]

Tall_Allen, What is your opinion?

[Tall_Allen in reply to daniellt]

MSI-hi/dMMR is very rare. I would ask an oncologist who has used Keytruda for it. My impression, which may be incorrect, is that only Keytruda is needed.

[tennis8285 in reply to Tall_Allen]

Thanks again. I have maybe three months before I have to make my decision to drop Lupron. If you do run across any relevant studies in the future, please reply to my post accordingly.

[Tall_Allen in reply to tennis8285]

I certainly will! All I have in my file is this:

journals.plos.org/plosone/a...

It doesn't give a clue as to what happens after Keytruda.

[tennis8285 in reply to Tall_Allen]

Tall_Allen,I got my lupron shot last week which completes two years of ADT. Yesterday, my oncologist agreed to my taking a vacation from ADT while continuing with my keytruda. Of course, this assumes my psa remains undetectable. He also wants me to do another genomic test via blood draw. So we drew the blood yesterday and will wait on the results.

My psa has been undetectable for 18 months now. Just a FYI for you since we have corresponded before. Thanks.

[Tall_Allen in reply to tennis8285]

Thanks. Let me know how it goes.

[tango65]

I would not risk it. You never know if the cancer can be put back to where it is right now. If you stop you should measure PSA and testosterone at least every month. It could take months for testosterone to recover after stopping Lupron.

[j-o-h-n]

No vacation....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 12/06/2021 11:35 PM EST