When to go back on ADT

[lewicki]

PSA is now < 0.02. Off of ADT now for fourteen months. On vacation. Do I go back on now as a precaution or wait till PSA rises and to what number?

Also, if I decide to do high testosterone treatment is this a good time ?

Thanks

[GP24]

In this study they waited until the PSA value reached 10 ng/ml and then started ADT again.

nejm.org/doi/full/10.1056/n...

[lewicki in reply to GP24]

Very interesting. Thanks

[Hidden]

Appears LU-177 was wildly successful and you’re ready to go back on ADT? I must be missing something

[lewicki in reply to Hidden]

I did AC-225 and LU-177 at the university of Heidelberg. Four trips. I had an Axumin scan two months ago and a PSMA scan July 2020 at the University of Indiana that showed some uptake in the prostate. Has not seemed to progress. So what is its status? Dormant ? Being pro-active .

[LearnAll in reply to lewicki]

Many studies about intermittent ADT chose PSA 4.0 as low point and 10.0 ng/ml as high set point. But this is for non aggressive, low gleason Prostate cancer with absent germline mutations and other aggressive variant features. It only applies to men with fully intact prostates.

[lewicki in reply to LearnAll]

Interesting. I still have it and untreated.

[HopingForTheBest1]

Unfortunately a high testosterone treatment regimen is neither widely accepted/used nor proven to be effective. Tread carefully and do your research before you decide to move forward.

It is difficult to find a doctor who will treat accordingly. I understand that Dr. Denmeade at Johns Hopkins is a possible option.

[lewicki in reply to HopingForTheBest1]

Thanks. I do have a doctor willing to do this. But I am not ready to chance it.

[DarkEnergy]

Awesome, congrats - took vacation when PSA <0.02, last ADT treatment was around 04/06/20, but ended when PSA was doubling monthly.

2/18/21 5/19/21 6/25/21 7/22/21 8/19/21 9/16/21 10/22/21 12/3/21

<0.02 0.09 0.18 0.27 0.55 1.10 2.17 0.20

[maley2711]

????

[Hawk56]

Here's my clinical history in chart form. After my third treatment that started in Jan 2017 and finished with my last Lupron shot in May 2018, my PSA has "bounced around." My urologist has no explanation, recommends we not do anything until there is clear evidence of a continuous upward rise, with the newer PSMA base imagining he recommends between .5-1 or higher, then determine if to treat, when and with what. He's comfortable not doing anything now, so am I.

Treatment Summary 2014-2021

[NecessarilySo]

I was on vacation from ADT for four years while my PSA rose to 39. I kept my eye on scans and was comfortable with waiting. After the four years I went back to continuous ADT and my PSA dropped back down to <0.1 for the past two years. Looking back on it I think it was kind of risky and I should have used PSA 10 as a limit. But I got away with it. I think it all depends on the agressiveness and your own situation. Every case is different.

PSA chart 2008-2021

[maley2711 in reply to NecessarilySo]

Picking these PSA limits seems rather arbitrary. NALS method is eveidently based on some actual study.....and the admittedly very little I know about cancer at cellular level would lead me to believe that adaptive might actually seem intuitive.....though intuitive does not always pan out!! Biological/biochemical sciense is SO complex.....perhaps why so many look to the Creator for the answers?

[Hidden]

So he needs to go back on ADT for awhile

[lewicki in reply to Hidden]

Yes. I am now aware of doing this. I have been without ADT for 14 months with a PSA of < 0.02.. I also know there is some uptake of PSA from the PSMA scan and the recent Axumin scan. I talked with a radiologist and yep I need to radiate. I talked to a Oncologist and yep he wants do chemo. Neither suggested going back on ADT. Hmmmm.

[lewicki]

Hello Nalakrats, I went back three years today to find posts on this and to re read and refresh . I was not able to find anything. Is it in daily posts. If there is a way to access this I need to find out how.Thanks for your help.

[maley2711]

And when you resume your previous treatment that was working,,,your rule for when to stop again, and begin another vacation? Based on that study? Could DR. Google find it ?

[MateoBeach]

If you don’t measure your testosterone level when you do your PSAs then you are in the dark. A vacations is not real unless testosterone recovers. If it is low, even if not castrate then there is no real benefit and has been shown to be worse for PC growth than either castrate or high T levels.A single trial of one month of high, SPT, testosterone replacement followed by a month off it would show you whether or not you are a favorable responder to some form of modified BAT. If PSA rises sharply you can simply discontinue it. “Very unlikely to cause you harm at that (low level PSA and scans)” as my consultants concluded. On that basis I started “adaptive therapy” modified BAT - high dose T for two months then one month off. When PSA gets up to 0.20 at end of a cycle I will add Firmagon or Orgovix to the “off” month.

If the prostate is the only site of PSMA activity I would strongly consider RT to it and probably also pelvic nodes.

[lewicki in reply to MateoBeach]

Thanks

[lewicki]

Thank you very much.