After a couple of delays I finally had the appointment with my MO regarding re-starting ADT. To review, I've been on a year long ADT vacation, my second vacation. This vacation was approximately 18 months after completing RT. A PSMA scan showed 4 small spots on my ilium very close to my previous mets. They may have been there all along but were not seen until the PSMA scan. My RO did not recommend additional RT for these new mets and agreed with my MO that ADT was the preferred treatment, at least for now.
I had a long discussion with my MO as to what ADT path I would take this time. Given my previous success with Lupron it was a given that I would restart Lupron. The question was whether anything else would be added. We discussed the studies pertaining to adding a second level ADT med, like Abiraterone, that showed a potential survival advantage. We also discussed adding Erleada and Abiraterone. Ultimately, I elected not to add anything to the Lupron. The critical points were that Lupron alone greatly reduced my PSA in the past. If I find that Lupron isn't as effective as before I will revisit the decision. Also, the plan is for this to be intermittent treatment. I fully expect to have another vacation in the hopefully not too distant future. If I expected to stay on ADT permanently I would have been more open to adding another med. For me it's a matter of balancing QOL with treatment effectiveness. Additional meds further reduce QOL, even more than Lupron. Lupron is bad enough. My MO is okay with this. We're on the same page. If I had insisted he would have also prescribed the other meds but he is sensitive to QOL factors.
Nothing is curative. This whole battle is one of delaying tactics while maintaining as a high of QOL as I can for as long as I can. There may come a time when I have no choice but to drop intermittent ADT and go down a different path but not now. I going to ride this as long as I can.
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fireandice123
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When I compare my two rounds of ADT, one with Lupron only and one with Lupron and Zytiga, I found no differences in which SEs I experienced. But they were less intense when just on Lupron, particularly fatigue and weight gain. Inexact method of comparison I realize.
That's consistent with the randomized comparisons of Lupron-alone vs Lupron+Zytiga:
"Among the 1476 patients in the safety population in whom progression had not occurred within the first year, the prevalence of adverse events of grade 3 or higher was 15% in the combination group and 11% in the ADT- alone group. The main additional adverse events over and above the control therapy were hypertension (5% vs 1%), mild increases in aminotransferase levels (7% vs 1%), and respiratory disorders (5% vs 2%). "
I urge you to reconsider. I’m Also on my second vacation and each time I added Zytega to Lupron. It’s a no brainer. Men live longer using both and the side affects aren’t much worse. Let me provide the illustration below. After five years an extra 1 in 5 men are alive in the group adding Zytega vs the group on Lupron alone. That’s a lot. 20% more alive. I still don’t understand the why not part?
This came from the latitude and Stampede trials. Both of which showed huge advantages to adding Zytega to Lupron vs Lupron alone. It did not compare other options. However a more recent study compared Lupron and Zytega to Lupron / Zytega and chemo for newly diagnosed men with mets and showed the triplet therapy to be even better.
Benefit of adding Zytiga, of course, but those statistics don't cover intermittent application of the drugs I'm sure...
And I would be interested in that data, ie, removing the drugs for a time and tracking progression. For example, when you stop, what's the plan to re-engage? Is PSA monitored monthly? What threshold to restart ADT therapy?
I would be interested if there is data pertaining to intermittent treatment as well. A key factor in my decision was the plan to go with intermittent treatment. Neither my MO nor I have seen such information. Thanks.
And you won’t. Studies of that nature begin with a hypothesis that something might be better. Why would one think that intermittent therapy would be better with Lupron alone when continuous therapy proved adding Zytega was so much better.m? Therefore in my opinion, It would be unethical to do a study comparing Lupron to Lupron and Zytega pertaining to intermittent treatment given the overwhelming evidence that adding Zytega was far better.
Your mixing apples and oranges. The studies have proven adding Zytega reduces deaths. Why would that change in intermittent therapy. Now the best way to do intermittent therapy still does need more study but the studies to date have shown intermittent therapy to not be inferior to continuous therapy.
Actually, no I'm not mixing anything... Those studies show the drugs being used continuously. Have you read them?
Why would the results change when stopping the drugs? Really? Lol, no reason at all. I'm not saying it would or will, only that the method has not been given it's sunshine in studies to observe the effect and whether or not it would change. But for a large amount of patients, stopping drug(s) usually has an effect, and not in a positive manner.
As I've said, it would be interesting removing the drugs for a time, in the intermittent manner and observing the result. If you have any data linking that I would appreciate it. Otherwise assumptions are being made.
My two cents. Being “OK with” is usually not the same as asking, “Doc if you were in my shoes, what would you do if you had metastatic prostate cancer?”
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