intermitten adt with erleada

[elkmt]

is intermitten adt+erleada advisable with 6 mt <.06 .i have already stoped once before and stayed <.06 for 5mt till i got to .1 . intial psa 17 gleson 8 rp 1lymp node with seminal invasion .went from .17 to4 with 5mt dt. f-18 showed spot on pelvic bone and inguinal ln. 68grays with adt &erleada got me to <.06

[Tall_Allen]

If it gives you a break from side effects, it's a reasonable choice.

[elkmt in reply to Tall_Allen]

thanks for advise.do you think if checked psa monthly and went back on adt+erleada when i reached .1 that i could delay cr . should i be hopefull about staying <.06 for 6 mt after i stoped adt and then went to .1.

[Tall_Allen in reply to elkmt]

It will NOT delay castration resistance.

[elkmt in reply to Tall_Allen]

do you think erleada is a game changer or just another antigen inhibitor.

[Tall_Allen in reply to elkmt]

I don't know what you mean. It is a powerful anti-androgen.

[swwags in reply to Tall_Allen]

I've read conflicting information on this here on HU. TA can you please post the research? Thank you in advance. Is everyone in agreement that vacations do not postpone castration resistance?

[Tall_Allen in reply to swwags]

Here is the EVIDENCE ( yet again). Yes, there is general agreement about it among doctors who research it, except among certain people on HU.

Some patients (and doctors) believe that by delaying ADT, they can increase their quality of life, and delay castration resistance. Neither is true. Contrary to popular belief, decreasing the intensity of hormone therapy and delaying its use brings earlier castration resistance and death. The strongest evidence for this comes from the STAMPEDE (on Zytiga and Xtandi), LATITUDE, and SPARTAN trials. Among men who were newly diagnosed with metastatic prostate cancer:

•Overall survival was longer if men used Zytiga + ADT.

---No difference based on the number of metastases

---Failure-free survival was longer if they used Zytiga + ADT

•Overall survival was longer if men used Xtandi+ADT

---Survival was especially lengthened if there were fewer metastases

---PSA progression-free survival was longer if they used Xtandi+ADT

• Overall survival was longer if men used Erleada+ADT

---PSA progression-free survival was longer if they used Erleada+ADT

A clear pattern emerges: early use of intensive hormone therapy prolongs survival and prolongs the time to castration resistance. Men who were oligometastatic benefited from early, intense hormone therapy.

The TROG 03.04 RADAR trial examined the duration of hormone therapy in high-risk men treated with radiation. They found that, after 10 years of follow-up, men treated with 18 months of ADT survived longer, and reached castration resistance later compared to men treated with 6 months of ADT.

The TOAD trial looked at starting ADT at the first sign of recurrence vs. waiting for metastases to be detected. Men treated earlier reached castration resistance later. It also showed there was no major detriment to global health-related quality of life by starting ADT earlier.

Maha Hussain reported the results of a randomized clinical trial comparing intermittent vs continuous ADT in recurrent men with metastases. She found that:

Time to castration resistance was not different for the two protocols (Figure S5)

For men with minimal disease, overall survival was 6.9 years for those on continuous therapy vs 5.4 years for those on intermittent therapy. The trial was underpowered for this difference to reach statistical significance.

It took 4-5 years for the survival curves to start separating - long follow-up is needed to detect survival differences.

Taken together, all these major randomized clinical trials show that the best way to use ADT in the oligometastatic setting is to use it early and heavily. Reducing the number of cancer cells as quickly and effectively as possible, even reducing those cells that haven't begun to measurably contribute to PSA, extends survival. The effect of evolutionary selection pressure allowing castration-resistant cells to survive is dwarfed by the reduction in sheer numbers.

[swwags in reply to Tall_Allen]

Thank you first of all and a couple of thoughts. All CAPS are not necessary or appreciated. Trying to ferret though this website for information is not easy and the site reads like one long sentence with the topics changing continuously. I have searched for this. Your patience is appreciated.

Also please recognize that I am not in the medical profession and not a scientist. I'm just a guy with cancer trying to survive. and only think and speak in layman's terms as I try to learn.

Ok that said, your first three dot points don't address a vacation in any way. They just state that if one uses a combination of drugs, they are better off than ADT only, based on randomized trials. The trials certainly have merit but don't answer the question. While you mention progression free survival rates, you are pointing to a combination of drugs, not a duration of therapy or an impact from a vacation.

The TROG 03.04 RADAR trial is addressing 18 months vs 6 months of ADT, not a vacation. Of course one would assume that progression of the disease would be more rapid using ADT over a shorter period.

The TOAD trial has some merit but again, addresses too little. Specifically it states "minimal disease". None of us here have "minimal disease"

I also spoke with Kwon about this today and I know you're not a fan. He neither agreed or disagreed with the question of whether or not taking a vacation shortens life span. He simply said he hasn't seen enough data to support either claim of a significant advantage.

I fail to understand how one can reach resistance to a drug sooner by taking a break from the use of the drug.

I hope this doesn't read as a curt rebuttal. You indicate it's Evidence. I don't see it.

Guys, anyone who can maybe translate this into something like an analogy would be appreciated.

I will admit in advance to being dimwitted, dazed and confused.

[Tall_Allen in reply to swwags]

I don't understand what you are talking about when you say "all caps." Do you mean the names of the trials? If so, they were named with those capital letters by the investigators, not me.

You asked if reducing the hormone therapy will increase the time to castration resistance. I showed you the evidence that the opposite is true. If more hormone therapy increases the time to castration resistance, how can less hormone therapy (using iADT) accomplish that?

Maha Hussain's trial directly addressed iADT. As I stated above, "Maha Hussain reported the results of a randomized clinical trial comparing intermittent vs continuous ADT in recurrent men with metastases. She found that:Time to castration resistance was not different for the two protocols (Figure S5)"

What you do not understand is that genomic breakdown continues with or without ADT. Heavier, continuous use of hormone therapy curtails the number of castration resistant clones.

So I'm sorry that you are blinding yourself to the evidence, but that is what the data tell us. It seems pretty clear.

[swwags in reply to Tall_Allen]

Thank you. This was your all caps, the one word in this sentence and then followed by the words "yet again" as though you've explained it to me before -

"Here is the EVIDENCE ( yet again). "

and now - "So I'm sorry that you are blinding yourself to the evidence", which is not in caps but I'm asking for help and trying to understand, not blinding myself.

I don't think in your terms and clearly you don't think in mine, but it may help you to understand many of us are neophytes here. What to you is deemed a statement of fact, to me opens a door to understand its meaning.

If you had simply started your initial response with this one in your last post. -

"What you do not understand is that genomic breakdown continues with or without ADT. Heavier, continuous use of hormone therapy curtails the number of castration resistant clones."

For me , and I can guarantee many others who are not in the field, that statement is a start to understanding what you meant when you said "It will NOT delay castration resistance."

It would have still led to more questions but now I have a starting point to research.

Please understand a question to you is not a challenge to your skillset, knowledge base or intellect. It's simply a question and when you reply in terms I don't understand, I will ask more.

You run a support group, no? Surely not everyone in your group has your background or expertise.

Let's let it go. I've asked, you answered. I'm good.

[Tall_Allen in reply to swwags]

I have no idea what you don't know that caused you to block out the evidence. I thought the Hussain trial was very clear. Perhaps I should have just recommended you read it a few times. I would have thought you are motivated to do that on your own. Many patients think that the way they reason is how the cancer behaves. One can't reason these things, one has to look at EVIDENCE. Caps is appropriate because I have to convince patients all the time that only EVIDENCE matters in biology. In physics, one can reason from laws, but biology is not physics. .I'm glad that you now understand that iADT will NOT delay castration resistance.

[j-o-h-n]

Hello mountain elk.... (my guess 1,736 blueberries in your avatar)....

Would you please be kind enough to tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 02/20/2022 8:03 PM EST

[elkmt in reply to j-o-h-n]

i am a 72 yr old elk chasing(photos)montana red neck diagnosed in 2018 with initial psa 0f 17 with a gleason (4+4)10%5=9,rp showed seminal invasion &1 out of 20 nodes with no positive margins . psa after rp was .17 which went to 4 in 1.5 yr (5.5 doubling time).f-18 showed axiumin up take on pelvic crest(very small) &bilinguial ln. under went rt at kailspell rh (68 grays) while taking adt. psa currently holding at <0.6(equipment at libby can not read read below that level)

[j-o-h-n]

Well thank you sir for your quick and detailed response. You may wish to copy and paste your response in your home page for future inquiries. Stay with us and post as often as need be.... Keep well...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 02/20/2022 9:50 PM EST

[Schwah]

My MO Dr. Scholz had the same advise for me. I got to .02 and after 24 months I had a vacation. It was great. I’m on my second stint after my PSA rise snd they found one very small met at L-5 which I did SBRT and back to Lupron and Zytega . What are yours and your doctors thoughts on how long to go on round 2. Scholz thought a year this time after getting back to .03.

Schwah

[MateoBeach]

Yes longer “vacations) cycling make more sense. The purpose is to recover T (total and free) to normal range so you can enjoy the benefits: put muscle and endurance back on, recover energy and libido. Go get your elk. If it takes T too long to recover from ADT suppressed testicles. Then supplementing with Testosterone injections makes more sense than sitting on the side lines. Testosterone recovery during ADT vacations is the whole point!

[elkmt]

i often see very low psa numbers 0n your post. my lab will only read down to <.06(total). are these low number (free) psa. my total psa has been <.06 for 16 months with a free psa of <.01 .

[elkmt]

thanks for the info.i now have 16 months <.06 including 6month vacation .when i reached.1 restarted adt . 1st mt <.1 2nd mt<.06. planning 2 more months on adt giving me 1year on adt <.06 plus 6 month vacation of mostly <.06(5 mt). 1 doc says i should stay on adt for 2.5 years while another thinks i should take a break. any advise

[elkmt]

needle core biopsies showed G(4+5) grade 5 in 2 cores. pathology from rp G (4+4) 5(10%) with no postive margin ,one ln and seminal invasion. post rp psa .17 which went to 4 in 1.5 years. f-18 scan showed small lesion on pelvic crest and 1 iliac ln uptake which were treated with 68 grays after 4 months at <.06. i did no see any of the above terms in pathology report but have always assumed a G 9 was undifferentiated. will get guest psa from pc doc.how do i send you private message.will get gene mutation evaluation asap.

[elkmt]

i would love to make $200 donation with a check . need address. not good with computers . i cannot get to your message