Intermittent ADT

[Tall_Allen]

It's a difficult decision. Here are things to consider:

prostatecancer.news/2023/04...

[cesanon]

If anyone is interested in this subject, you really need to go read TA's link.

It is a tour de force on the subject, covering pretty much every possible nuance on the subject.

[Bdale]

TA, thanks, as usual your posts are spot on. I am metastatic and because I was resigned to a life with ADT my choice was an Orchiectomy which happened yesterday. So no vacations, but also no more Lupron shots.

[dhccpa in reply to Bdale]

Any hot flashes, sweats, etc., Other SEs?

Thanks.

[Bdale in reply to dhccpa]

Nothing yet, but I've been on Lupron for 3 years so castrated fully. I had hot flashes early on, but haven't had that problem for a while. I wonder if that'll start now. The nether region looks awful right now, purple penis and scrotum.

[dhccpa in reply to Bdale]

Yes, I haven't considered that. I get a Lupron shot every quarter. Waiting for the shoe to drop.

[45yrsDenmark]

Thank you so much for sharing this. It is a fantastic compilation. Highly appreciated

[davidw777]

Thank you so much for this! It’s very timely for me as I will be meeting with my MO in June to decide go/no-go for a vacation.

[Fiddler2004]

Entering my 4th year of treatments and this is the best, all in one place, explanations of ADT/trials/outcomes I've read to date (still reading your post) Thank you very much for sharing this information 🙏

[raoulmaher]

Explained to me - Intermittent ADT - we are cutting the grass with our treatments and stopping treatment - ADT holiday will allow the grass to spread !!! - yes there is testostererone flooding by which time more roots will have grown - My take - keep on top of the grass triming - dont let it spread - and give yourself a fighting chance - thank you TA for your input - Kindest Raoul

[mangeycritter in reply to raoulmaher]

Maybe, maybe not. Depends on many things, as TA succinctly points out. BCR 2016, 4 yrs. post op. DT=9 months. ADT begun in 2020 @ PSA 5.7. 1 month later PSA <0.1. T =7. ADT continued 12 months to May 2021. PSA always <0.1 or ultra 0.01, T = 375. Vacation begun May 19, 2020. Continues to date; last measure April 14: PSA 0.04, T = 325. Age 82 in Sep. Duke MO.

[mangeycritter in reply to mangeycritter]

correction--vacation begun May 19, 2021.

[KocoPr in reply to mangeycritter]

Thats great news for you! So you have been on vacation for 2 years now?

Im sure your watching it like a hawk. What’s your plan if recurrence just jump back on same ADT or try the newer one like Orgovyx and an ARi like darolutamide?

[mangeycritter in reply to KocoPr]

Two years on May 19. In Apr. 14 session MO said will have 3 month ultra PSA measures along with virtual visits. Said may do PSMA scan when PSA reaches 2 or so. If negative, will continue 3 month monitoring until PSA reaches the level at which ADT was first initiated---5.7 or so. MO is at Duke (Duke med school, Johns Hopkins fellow, regular contributor to this forum) and few years ago when on ADT I questioned him if we should be using the double or triplet therapies. His reply: "rest assured we will treat you as aggressively as your prostate cancer." As has been said many times here, every case seems to be different, at least in some particular. Few years ago genetic testing done at MSK found only one variant--"SPOP" (if I recall correctly). MO there said that was good, as patients with SPOP respond very well to ADT. While anecdotal, my experience and treatment course is still data to be added to the quandary of ADT v iADT. Please remember, I am nowhere near as well informed as most others on this forum, and am only recounting my personal experiences. I would weigh any counter opinions more heavily than mine.

[dhccpa in reply to mangeycritter]

Were you on both Lupron and Zytiga or Xtandi? Or just Lupron? Thanks

[mangeycritter in reply to dhccpa]

Per Nalacrat (subsequently banished here), Vantas implant at Levine Cancer Center in Charlotte. I think Vantas no longer available. Duke MO was fine with Vantas. No other ADT or anti-androgen.

[dhccpa in reply to mangeycritter]

Ok thanks I haven't heard of it but will look up.

[anonymoose2 in reply to raoulmaher]

interesting analysis. 😊

[Heykm01]

thanks TA for this post. Many of us will be facing this choice.

[milehigh]

Thanks Allen. That’s very interesting. Any further information on ischemic risks for mHSPC on intermittent ADT?

[Ahk1]

as always, you are the BEST. Great analysis

[FISHLAND]

Merci pour toutes ces explications

[Gearhead]

"Don't kill the messenger" I try hard to live by that, but sometimes it's hard.

So, thank you for this. excellent, well-documented, and unbiased-sounding cADT-iADT summary. I wish it was more encouraging regarding iADT as a strategy for relief from the fatigue-following-modest exercise, high BP, and osteopenia cumulative effects of my 4-years of ADT.

[Papa1]

Thanks. Never really considered iADT in my situation, but now I know with more certainty why.

[Mcrpca]

Although it’s 23 years too late to change the decisions already made, my husband had 9 months of Lupron & Casodex immediately following radical prostatectomy because of failure to achieve a nadir PSA post surgery. He’s had a wonderful quality of life and no real issues until 2020. Now back on ADT and receiving Zofigo for bone mets with Xgeva to help prevent fractures. He’s 80 + years old and we wouldn’t have done it any other way. Thanks for the interesting summary. You always have good, science-based information.

[FrankyB4]

Thanks for this. Very pleased that you broke things down into “settings “. I wish every discussion on this site was categorized into a setting to avoid misunderstanding and confusion. Thanks again.

[michael00]

One more month I'll be 5 years on ADT (eligard and zytiga) no other treatments. I have no plans to consider a vacation from ADT,. To me its not worth the risk when I'm eunning a PSA of <0.04 for a long time now.

[Survivor86]

Thank you TA. Your presentation of this information is very helpful. The dilemma for me is that while I currently have mHSPC, and am on my second vacation from ADT now, the rising PSA level which led to a PET scan that revealed metastases to my upper spine and right femur, resulting in SBRT and a resumption of ADT after my first vacation from treatment of almost three years, was considerably lower than the threshold value for resuming ADT used in the large randomized trial. I will discuss the criteria for ending my current vacation (now in its 8th month) when I see my MO in two weeks but am still wondering about the extent to which the cited study and data analysis are applicable to someone in my situation.

[Tall_Allen in reply to Survivor86]

Your situation is described in Protocol #9 - MDT. I think you have to use PET scans (preferably NaF18) rather than PSA to monitor progression.

[Survivor86 in reply to Tall_Allen]

Thank you!

[Ingress]

I am a firm believer in “if it ain’t broke, don’t fix it”. Like everything else with this disease it is depends on how each person may or may not respond to stopping ADT. Does ADT suck? Absolutely! Am I still non detectable after 21 months on ADT? Yes. Would I ever run the risk of stopping ADT and give the cancer a chance to possibly return? Never. Tread carefully. PCa is evil and just waiting to find a way to screw you and your loved ones over.

[London441]

Thanks for this TA. With all the advances in medicine (Orgovyx in particular) adaptive IADT etc there are certainly more options, but all told it’s still the same. The unpleasant and potentially dangerous effects of ADT await us when we start, and it’s swimming upstream from there. The better our overall health at baseline the better our chances to fight effectively. To this end, as you describe at the bottom of the article, aerobic and weight bearing exercise is the most important difference you can make.

Depending on return of T alone to provide relief from ADT side effects without exercise is pretty much futile for most during IADT. Return of T can be so slow that PSA rises before it does, and the consequences of ADT induced sarcopenia are usually dramatic, cumulative, and cannot be rectified simply by restoring T.

Of course, for older men, or those with low baseline T, the side effects are often negligible due to the ‘can’t lose what you don’t have’ theory.

For the rest of us, the more exercise the better. When I hear or read about guys taking ADT vacations so I can ‘start getting my strength back’ I shake my head. Now is (and always has been) the time for that.

[Balsam01]

This is excellent! Thanks for your work on this site!

[anonymoose2]

“No one likes Androgen Deprivation Therapy (ADT). Even in the short term, there are hot flashes to contend with, fatigue, and loss of libido. Longer term, there may be cardiovascular side effects, bone loss, fat gain, brain fog, low red blood cell count, blood sugar dysregulation, and mood swings.”

I agree.

Now back on ADT after 8 month vacation and I still agree.

In those 8 months got to see the wife smile the children laugh, travel without bumping into walls, sleep like a baby, hook up with friends and family and have some great laughs. No more barking at the wife and dog and doctors, blood pressure and sugar returned to normal and no thought of ending my life. Yes it was a great 8 months.

[Seasid in reply to anonymoose2]

I am fine on my Degarelix ADT. Much better than with the cancer. I was polymetastatic with distant mets in my spine and neck. I don't have hot flashes, nor mood swings, nor I am behaving badly. Actually I am happy.

How quickly your testosterone levels recovered and up to which level? How long did you spend on ADT?

[fourputt]

Great timing for me and I'm sure others. Much appreciated.

[j-o-h-n]

Intermittent = one of my favorite words in the English dictionary...... followed by word Sex.......... somehow the two go/come together.......

Good Luck, Good Heath and Good Humor.

j-o-h-n Friday 04/28/2023 3:59PM DST

[dhccpa in reply to j-o-h-n]

Does the resumption date seem to move farther and farther away?

[Runner4000]

Thank you! Very helpful, although a bit scary....

[ShipModeler]

Excellent article. I wish there was a quicker way to recovering our manhood, but we can’t have both a better quality life or a longer life of sufficient quality.

[garyjp9]

thank you, TA

[dhccpa]

Looks very interesting, TA. I'm going to dwell on it in greater detail later today.

Any plans to do a similar article on BAT therapy?

I fear neither of those has reached doctors in my area, but then I haven't demanded it.

[Tall_Allen in reply to dhccpa]

I have always updated my article on BAT over the last 7 years:

prostatecancer.news/2016/09...

It should never be done outside of clinical trials, preferably at Johns Hopkins - it can be very dangerous.

[dhccpa in reply to Tall_Allen]

Thanks. Yes, I understand it's experimental. I'm not anywhere close to even being a candidate yet, but am keeping an eye on it.

[Researchshortcut]

Thank you. Very informative and succinctly composed. I always read your posts.

Jeff