Best use of Psa to guide intermittent hormone therapy

[rococo]

presently on relugolix + Darolutamide for local reccurrence and will go off these drugs if Psa is less than .65 three months ago tested and go back on when Psa reaches 3-5.. Seems it will be about 6months and hopefully 6 months off, Tentative protocol so far. Input from all and for all welcomed. Thanks to all

[cesces]

It seemed for a while intermittent hormone therapy was a standard of care.

Maybe it still is.

But I think it was basically a few years on and a few years off.

6 months seems too short. Way too short.

[London441 in reply to cesces]

Well obviously it’s a risk to take ‘a few years off’ if PSA starts rising substantially during IADT. The problem has always been vacations are that long because T return is often so slow.

A 2 year vacation where a man remains at castrate (or at least very low) level T through much of it serves little of the desired purpose.

Perhaps the relatively new Relugolix has changed IADT thinking since it clears the body so much faster than Lupron etc upon stopping.

[cesces in reply to London441]

Basically you need to watch the psa levels and adapt to them

They really govern the length of the cycles.

[austinsurvivor]

been on orgovyx for going on 3 years….my MO has me going on ADT vacation when undetectable for 4 months, then back on ADT when PSA rises to 2.0……been doing this for over 2 years and I usually get 4-5 months of vaca before hitting the threshold….my T value has always came back within 1 month of off meds….good luck!

[MateoBeach]

Having objective pre-selected PSA criteria for starting and stopping IADT seems wise to me. The values chosen are selected for the individual based on clinical status etc. Rather than a fixed formula. A baseline level of PSA you and your MO are comfortable with to stop the ADT, in your case 0.65 as your baseline. Then how high to let it go before restarting. 3-5 is not unreasonable to start and can be modified in subsequent cycles. Repeating scans to identify radiographic progression will also be important to consider.

This is an “adaptive therapy” approach. Cycling castrate and recovered testosterone. Hopefully, using Relugolix and darolutamide you will have faster T recovery when stopping them, but verify with lab tests.

A recent trial of adaptive abiraterone demonstrated rather excellent results. These were on continuous ADT and just cycled the abiraterone. Starting/using it until PSA levels dropped by half. Then stopping until PSA recovered to their personal baseline. It proved to be substantially better than the cohort that chose to stay on continuous ADT plus abiraterone.

elifesciences.org/articles/...

Good luck and please report progress. Paul /MB

[Nfler]

Hi Roco, I was on about the same trx as you relugolix n Abi for about 7 mo and decided to go off but incorporated ivermectin at the end of adt n then continued it 4 days on 3 days off at 12 mg and my psa went from 1.92 to 1.83 to 1.52 at the two week blood work each time. I ran it thru my med onc n he approved n said as long as it’s working we can stay on it but if n when psa rises then may consider getting back on adt again. Just my results n thoughts, I’ll keep u posted…😁

[fmenninger]

Please note at this time Relugolix is sometimes declined by insurance companies as Degarelix is similar hormonal drug. My MO requested this for me and was denied by insurance with no ability to make an appeal. Uuuggghhhh…..