Intermittent ADT

[epfj3333]

2015 - PSA 6.0, Gleason 4+3=7. Prostatectomy, 40 radiation treatments and 7 months Lupron. PSA was soon undetectable. Stayed that way until 2020. It slowly increased to 7.3 in 2021. Ga68PSMA and Auxumin (?) Pet scans all showed nothing. Started on Firmagon. PSA went to undetectable within two weeks. Doctor said we'd stay on this course for one year and then stop and monitor the progress. If PSA starts creeping again we'd start up the Firmagon again. Is taking a break like this sound advice or should I be staying on Firmagon for life since it's working? The side effects are brutal, but like I said, it's working.

[Hidden]

Spoke to a Mayo MO day before yesterday that said intermittent is fine. Says the data shows it does have lower overall survival rates than continuous, but not to a major extent. Showed me the graphs with one line just a little bit lower than the other.

[tango65]

"Evidence (continuous vs. intermittent hormonal therapy):

A systematic review of 15 randomized trials that compared continuous ADT versus IAD therapy for patients with advanced or recurrent prostate cancer found no significant difference in OS, which was reported in eight of the trials" There was minimal difference in patient-reported QOL, but most trials found better physical and sexual functioning in patients in the IAD arms."

cancer.gov/types/prostate/h...

[Magnus1964]

I am not a fan of intermittent ADT treatments. Everyone's cancer is different and your doctor does not know if during one of your ADT "vacations" that new cells lines won't find a work-around to the drug. If a drug works, stay with it.

[Tall_Allen]

This is a very difficult question for which there are, as yet, no clear answers.

For men with no metastases, intermittent ADT (iADT) seems to have equivalent overall survival to continuous ADT (cADT) after RT (primary or salvage):

ncbi.nlm.nih.gov/labs/pmc/a...

But notice that prostate cancer-related deaths were 23% higher in the iADT group (Table 3). This difference was not statistically significant - possibly because the sample size was not large enough to show a statistically significant difference. Also there were very few SRT patients like you in this study (only 11% of the sample) - would that make a difference?

An interesting alternative is whether a single short course (≤1 yr) of advanced hormonals can forestall progression in recurrent but non-metastatic men. It seems to help using Zytiga, Xtandi, and Erleada:

urotoday.com/conference-hig...

ncbi.nlm.nih.gov/labs/pmc/a...

meetinglibrary.asco.org/rec...

There is an ongoing clinical trial combining a year of Zytiga+Erleada in recurrent men that you could possibly qualify for:

clinicaltrials.gov/ct2/show...

[epfj3333 in reply to Tall_Allen]

Originally, the doctor put me on Xtandi along with the Firmagon. After two weeks my PSA was undetectable. He said I had such a good response that he stopped the Xtandi. He said it was like stomping on an ant with both feet. He said we'd stay on the Firmagon for one year and see what happens after that.

[Tall_Allen in reply to epfj3333]

That seems to be evidence that some longer course of therapy would probably be effective for you. Maybe email him those trial results and consider entering the "androgen annihilation" clinical trial.

[epfj3333 in reply to Tall_Allen]

OK. Thanks!