Duration of ADT

[jjacha]

I need to make a decision about the duration of ADT. I had a prostatectomy in 2017. The pathology was great - everything suggested the disease was confined to the prostate. My PSA never went to zero. It has increased very slowly since then. I refused to have radiation until we has something to shoot at. In January, it reached 2.5 which enabled me to see Dr Kwon at Mayo. I saw him in May and had anMRI and Choline scan. They detected a remnant in the spot of the prostate and nothing anywhere else. I started ADT and had radiation to the spot and the pelvic lymph nodes. The radiation oncologist told me that 4-6 months of ADT was adequate but Kwon prefers a year. They are leaving it to me. I would love some input!

[Tall_Allen]

It's hard to advise you on duration of ADT, because your decision to only irradiate the one spot is not how the clinical trials that determined ADT duration were done. If you had irradiated the entire prostate bed, 4-6 months might have been adequate. You will have to make that decision on your own intuition,

[Nusch in reply to Tall_Allen]

Hi Allen, why 4-6 months, if entire prostate bed had been irradiated and not 2 years? I think to remember, that after irradiation of bed + PLN two years are the recommended time frame?

[Tall_Allen in reply to Nusch]

you have no known lymph node metastases, right? It's 2 years if there are lymph nodes. 4-6 months with low stable psa after prostatectomy. IDK if it can still be cured with your spot treatment or how much adt it would take. Because no one does what you did, there are no data for it.

[Nusch in reply to Tall_Allen]

I had three lymph node metastasis before we did full RT to prostate bed and pelvic drainage plus spot radiation, maybe you find time to see my bio. 🙏 Currently I would prefer to stay two years on Lupron as my SE are manageable.

[Tall_Allen in reply to Nusch]

Then you need at least 2 years of ADT, possibly with a second generation hormonal.

[Nusch in reply to Tall_Allen]

Many thx Allen, that’s what I will go for. Regarding 2nd gen hormonal I prefer Nubeqa, we will decide after my next PSMA Pet/CT in Jan 23.

[Tall_Allen in reply to Nusch]

It may be difficult to get Nubeqa outside of a clinical trial, because it is not indicated for this use.

[Nusch in reply to Tall_Allen]

My doctor would give it to me, covered by insurance.

[London441]

You did not radiate the prostate bed with a detectable PSA after surgery because there was ‘nothing to shoot at’, but quite likely there was plenty to shoot at microscopically. I’m sure you know that detectable PSA post RP is a poor prognostic indicator.

The year of ADT is not onerous if you get plenty of exercise, and it could make all the difference.

Having gone your own way thus far, maybe trusting Kwon would be a good choice at this point, but of course it’s your business.

[RMontana]

jjacha, try this...TNX

healthunlocked.com/active-s....

[ArmadilloChili]

I would choose the least amount of ADT possible. That’s just my personal opinion. I may be in your position soon. RP 10 years ago. My PSA has gone from < .10 to .10 recently. I never thought the < sign was so important 🤓

[jfoesq]

Boy- what I would have done to have ONLY been on ADT for a year. This wouldn't be a difficult choice for me. In my mind, one year is a breeze. Better safe than sorry!

[ron_bucher]

A year after my prostatectomy and my PSA reached 0.20, radiation of the local area with no ADT gave me 7.5 years of undetectable PSA.

Then at PSA 0.06 and doubling in 5 months, I had more lymph nodes radiated plus Taxotere plus 9 months of ADT. My docs wanted me on ADT for 18 months but I hated the side effects and didn't view ADT as curative. I also didn't want to wait any longer to see what my PSA would do after ADT. My PSA went undetectable for another 4+ years.

My personal strategy has been to act early at each step. Every doctor I've ever met has said the earlier one gets any particular treatment, the more effective that treatment is.

[Tied2work]

I had a RP in 2008. In 2021 my PSA crept up to 0.6 I started 4 mos ADT in September of 2021 with 37 radiation treatments to the entire prostate bed. PSA is undetectable. Good luck to you.