protocol for intermittent ADT

[Merlin1960]

so his psa rose after 2.5years of an ADT holiday and he took casodex for 4 weeks then had a 3 month zoladex implant , after 2 months he is undetectable again , we asked his oncologist what the protocol is for length of time on it this time and he said if he stayed undetectable that he could possibly come off it after 6 months, has anyone been on it for such a short time before taking a break ? Thanks

[Ahk1]

what was the last psa after the 2.5 years of vacation from ADT?

[Boywonder56]

You spun the cylinder....empty chamber.......if psa rose enough to warrant starting treatment.....means the bear is poking his head out....poke him again ....he might just bite.....if his apc is high grade as many of us.....vacations risky...but justmy 2 scheckels worth...good luck

[Merlin1960 in reply to Boywonder56]

after 16 months on casodex/zoladex his psa sat at 0.03 until it started rising after 2 years , by about 2years and 10 months vacation it was 0.5 , he responded so well to treatment again and the first psa test after 2 months of treatment is 0.01 his oncologist said that he may just need one more zoladex and then take another break . I had thought 18 months was typically how long he would be on it ..

he was oligometastatic from diagnosis with 2 mets on a pet scan , one to t12 and one pelvic lymph node , t12 was treated with radiotherapy, he had RRP and then 40 sessions to his prostate bed/lymph nodes ..

[Ahk1 in reply to Merlin1960]

was the pet scan you mentioned above that found the Mets is a psma pet scan?what kind of a pet scan?

[Merlin1960 in reply to Ahk1]

yes he had two pet scans one was Fluor 18 I think the other psma , Gehenna was diagnosed Gleason 9 with 11 cores cancerous , most 100% , he had a clear bone scan and a clear ct scan so we were happy then the doctor agreed to do the pet scan only to find mets to a pelvic lymph node and one to t12 …

[maley2711]

There are studies comparing continuous to intermittent...perhaps you can Google or pubmed and find more info from one or more of such studies. Did you ask Doc for his knowledge on this topic?

[Merlin1960 in reply to maley2711]

didn’t ask as he was rushing to a meeting, he is Turkish , they all helped set up the oncology hospital in Bahrain , I was just looking for other opinions and don’t trust what I come up with when I google , we will be leaving that country and will be back to uk nhs in 6 months .

[Murph256]

I have heard, both from my oncologist and from a knowledgeable member of this forum, that the rule of thumb is one year. That is, PSA should be undetectable for at least one year before the patient goes back on an ADT vacation.

[Petefromoverthepond]

I've been on Decapeptyl for 6 months now and my PSA has dropped to 0.15. I was hoping to have an ADT 'holiday' at some point soon especially as I'm starting a new relationship. Can anyone comment how long it takes to get proper sexual function back after coming off ADT please? .... in theory the loss of sexual function is entirely reversible I believe - what experiences have people had in this respect. Thanks in advance for any answers.

[MateoBeach in reply to Petefromoverthepond]

Recovery of sexual function depends upon recovery of normal effective testosterone levels. This varies widely and for some so slowly it can take a year. And for some it never comes back and require testosterone replacement, TRT, to overcome the deficit and restore normal function in all domains.

[austinsurvivor]

My MO has approved ADT vacations when my PSA goes undetectable for 3 or more months, then I go back on after it goes over 2.0, which takes about 4 months. I’m going on my 3rd year of this cycle and beats the hell out of continuous ADT. Also, I’m on Orgovyx not Lupron when on ADT with lymph node only mets. Since starting Orgovyx almost 3 years ago, I’ve always gone undetectable within 1 month of restarting ADT. We discussed just last week the on/off duration cycles and he said there is little data out on the duration cycles but since we are having such good results let’s stick with this current plan. I’m in Denver seeing my MO at RMCC.

[Merlin1960 in reply to austinsurvivor]

wow thank you .. I hadn’t heard of anyone on such a short time before taking a break !

[Nusch in reply to austinsurvivor]

Very interesting - many thx! I’m on my 18 month Lupron after RT to prostate bed and pelvic region after recurrence. I will discuss with my doctor in April when I get my last Lupron before vacation - if PSA remains undetectable. Wishing you the very best!

[Petefromoverthepond in reply to austinsurvivor]

Thanks very much for yiuyr reply - that's very useful. I'm guessing I'll have to be on ADT for at least a year before I can ask for a 'holiday'?

[Prostateless2020 in reply to austinsurvivor]

This is exactly my plan! Orgovyx for six months along with 39 sessions IMRT. Then observe. I too had an undetectable PSA after 4 weeks on Orgovyx with virtually no SE. Waiting until PSA get as high as 2.0 is a bit unnerving, though..

[RMontana]

Here is an article that affected my choice on how long to stay on ADT post recurrence. TNX

healthunlocked.com/active-s....

[MateoBeach]

His PC shows an indolent and slow growing character so far, which is so fortunate. So longer periods off ADT with testosterone recovered can be alternated with shorter periods on ADT. Much better for preserving body and mind functions and recovering from damage due to ADT. Furthermore, it may be less likely to progress to castrate resistance without the sustained exposure to castrate T levels.

The logic is the same as that for use of long cycle BAT. Periods of very high testosterone administration alternating with short periods of castrate T levels from ADT. Even one month of ADT appears sufficient to prevent progression for some, such as myself for two years now. But of course it must be regularly monitored to identify the need to modify or discontinue the strategy. As with any treatment regimen. 6 months should be plenty of time on ADT for him and hopefully not too long to permit CR to emerge.

[Merlin1960 in reply to MateoBeach]

fabulous thank you for your feedback, very encouraging

[TeleGuy]

I had two breaks during my initial treatment, each after six months of ADT and with an undetectable PSA. The catch was that we did FDG PET scans to determine that there was no evidence of disease before starting a break. I had one 14-month break and one 8-month break.

Here's one of the seminal papers on intermittent ADT, this one studied men after radiotherapy to the prostate:

nejm.org/doi/full/10.1056/N...

[Merlin1960 in reply to TeleGuy]

thanks so much , that’s great

[CRPCMan]

You have a great doctor. Intermittent is the answer to maintaining response and avoiding CRPC.