Wondering which arm of STAMPEDE dictated my 18 to 16 month ADT plus Zytiga treatment plan ?

[PBnative]

I have “ low metastatic load “ based on a clean PSMA -PET scan but I am high risk based on PSA 61 ( I was Gleason 6 on only biopsy in 2009 ) and “ probable” seminal vesicle EPE .

Taking Avodart for ten years and doing many lifestyle changes per Snuffy Meyers kept my PSA low for a decade but when I stopped Avodart for a month 3 years ago PSA began to rise . I finally got 26 radiation treatments at MSK in January 2022 and started Orgovyx and Zytiga with prednisone in November 2021 ( 5/22 PSA 0.2 , testosterone <3) . MSK RO and MO Rx ‘d 18 to 36 months of ADT plus Zytiga based on STAMPEDE . The STAMPEDE article posted by today by Spyder includes Docetaxel ( which I’m not taking ) in the trial .

Does anyone know which arm of Stampede dictates my treatment plan ?

[Tall_Allen]

It's this one:

ncbi.nlm.nih.gov/pmc/articl...

[PBnative in reply to Tall_Allen]

Thanks very much!!!

[jazj]

Curious about your reasoning behind choosing Avodart as your primary treatment in 2009 with Gleason 6 and PSA of 8? Obviously you had a biopsy to confirm you had Gleason 6. I doubt Dr. Meyers was making any promises about Avodart permanently eradicating or indefinitely stopping the cancer progression? My guess is you were just very leary of quality of life effects from doing a more radical primary treatment such as surgery or radiation despite with that PSA and Gleason either one of those (in my honest opinion) probably had a higher chance of curing you than Advodart?

[PBnative in reply to jazj]

Yes, I was thinking that maybe a Gl 6 would not progress so why be “over treated . There’s a book called INVASION of the PROSTATE SNATCHERS . H. Ballentyne Carter , who was a leader in active surveillance at Johns Hopkins , wrote that his AS program at Hopkins showed that if the cancer hadn’t progressed in 5 years , odds were very low that it would . I thought I was out of the woods 10 years out in 2019 , but then it progressed when I took a break from Avodart .

I didn’t think of it as a cure . I was thinking I might not need a cure .

[jazj]

I should add that the reason I found your thread is that I have been trying to do a deep dive into Avodart but more in the context of a potential alternative to ADT in the recurrence setting, not as a primary treatment. There's little long-term evidence in studies so your 10-year experience I find fascinating. I'm going to address Advodart and long-term outcomes in a separate thread.

[PBnative in reply to jazj]

My urologist told me the 2005 REDUCE trial ( check PubMed ) with around 8000 men showed that Avodart , while shrinking the prostate , reduced progression and in some cases seemed to “treat “ or eliminate Gl 6 cancers . There was controversy at the time because there seemed to be more Gl 8,9,10 showing up in years 4 and 5 of the trial. I can’t remember the details but my uro said he doubted that interpretation of the results so I took it . Not sure what Snuffy said at the time but I think he said Avodart was safe in active surveillance.

My uro is suggesting I start taking it again now that I’ve stopped 9 months of Orgovyx and Zytiga .

I don’t want to do ADT in case of recurrence so I look forward to your thread .

Message me for details if you like .

[PBnative in reply to jazj]

Dr Meyers was not my doctor . My uro and I paid attention to his newsletter and videos .