Ruminating on Extending ADT&Zytiga beyond 18 months

[TylexGP]

Please see my profile for details but I am T3bn1m0 with pni, SVI, BRCA2 positive with Intraductal histology. I am 15 months post HDR Brachytherapy with EBRT. PSA Continues to slowly decrease and currently is 0.06 last week. Last scans did not detect bone Mets or soft tissue Mets and suspected node no longer is visible. MO said we can consider stopping ADT at 18 months. My concern is there no good trials looking at High/ Very high risk locally advanced PCA and length of time of ADT. Only guidance 18 months to 36 months. ADT side effects suck but If 24 months gives me an edge for durable remission then I can suck it up and go until May. I know ultimately my decision but as always trying to make an informed decision. Thanks you for your thoughts.

[Tall_Allen]

Actually, the new standard of care for patients with lymph node metastases is 2 years of ADT+zytiga based on the new STAMPEDE trial:

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

Let your oncologist know that the latest NCCN update (last week) revises this as the new standard of care. "Abiraterone with ADT should be considered for a total of 2 years for those patients with N1 disease who are treated with radiation to the prostate and pelvic nodes. "

[TylexGP in reply to Tall_Allen]

Thanks TA very helpful!

[cesces in reply to Tall_Allen]

Would there be no benefit to pushing it an extra year, to 3 years?

[Tall_Allen in reply to cesces]

That wasn't tested.

[smileyva in reply to cesces]

My husband is G9 and was diagnosed in Sept 2019. Started Eligard/Zytiga/Prednisone in November 2019 and has been on it since. His PSA has continues to slowly drop over all this time. So, his doctor at Hopkins and we are of the “if it ain’t broke, don’t fix it” and will just keep trucking with the drugs.

The side effects are manageable for him, although they do stink.

I would love to hear some research about those who stay on it longer.

[TylexGP]

Thank you for sharing you are right. I’m already locked in for 18 month last 3 month Lupron last week. I can definitely suck it up and do the 24 months and that way feel I did all that I could.

[jfoesq]

I would've taken 2 years in a heartbeat. My condition was and remains full-on metastaic and have been on Lupron and Zytiga for most of my last 10 yeras+. If you can handle 18 months, my guess is you can handle another 6. Good luck!

[Hidden]

TilexGP, take the time to read and study the material that Allen linked. I was told by my Research and Professor Medical Oncologist that most misread. You have a Gleason(5+4) which is very high risk and serious. Please do not lock yourself in or limit your injections of Lupron.

Besides the trial cohort progression and death reported, pay attention to the trial protocol, “.... continue for 2 years or until progression, whichever came first. ” this is not limiting. Comparatively, I had Lupron/Eligard for 6 1/2 years before stopping..... I started the advanced prostate cancer journey in 2004 at age 57.

You can do this. BTW, I suggest that you research and discuss with your MO, “micro-metastates”.

Keep killing the little bastards,

GD

[TylexGP in reply to Hidden]

Thank you! Point well taken. I don’t want to short change myself on the ADT.

[Oceankayaker]

since your post was 10 mos ago I would like to hear an update. My dx very close G8, T3a,N1,M0 bone scan clear and nodes no longer show evidence of mets. EBRT with firmagon and zytiga. End of July is 18 mos and trying to decide if I want to go to 24.

[TylexGP in reply to Oceankayaker]

You have great timing😁. I chose to continue on ADT plus Zytiga for 24 months. My last 3 month Lupron shot was March 20 th. Stopped Zytiga and prednisone on May 31st. Today had labs CT Scan and NaF bone scan. Labs basically normal with PSA <0.05 the lowest it’s been. Testosterone also still undetectable. CT and Bone Scans both clean.

[Oceankayaker in reply to TylexGP]

thank you for the update. Happy to hear you are doing well.