End of holiday??

[R1166]

Hi everybody,

was wondering if you could share your experiences to help me decide the end of my ADT holiday.

In short: PCA found in 10/2019, PSA=49, Gleason=8, mets in local + infra/para aortal lymph nodes, started ADT 11/2019, radiotherapy 01/2020, undetectable PSA 09/2020, started holiday 05/2022.

After that PSA went: 11/2022=0.62, 03/2023= 1.5, 06/2023= 5.8

My urologist never suggested a holiday. The oncologist (on my request) gave the OK and said start again when PSA= 10-15. Is this safe? Am I not risking new metastasis development at that level? There has been tripling of PSA value every 3 months....feeling uncertain and worried about postponing again ADT ( also because going intermittent gave me back a good share of energy, mental focus and sexual activity (I'm a 57 years old boy

Wanna take the chance to thank all contributors...reading your posts has been of great support in this journey 🙏

[fireandice123]

I would recommend trying to get some scanning before just restarting ADT. At least bone and CT scans, preferably a PSMA scan. IMHO waiting until your PSA rises to 10 or higher before taking some action seems a bit reckless. I’m currently on my third vacation. Each time when my PSA started to rise my MO ordered scans. He wanted to see what was going on before restarting ADT. There wasn’t a predetermined PSA level that caused him to do that. It was just when it started rising to determine the next treatment. For the first vacation I think it was around 3 when he ordered bone and CT scans. For the second vacation he ordered the PSMA scan when my PSA rose to 0.9.

[R1166 in reply to fireandice123]

🙏

I have the feeling that here in the Netherlands they are quite conservative with requesting PSMA (only did it before treatment started in 2019)...I'll do my best to push for one

[fireandice123 in reply to R1166]

if not a PSMA scan maybe you can get the CT and bone scans. Better than nothing

[Tall_Allen]

If your para-aortic lymph nodes were treated, in addition to all your pelvic lymph nodes, it is possible your PCa could have been cured if you had stuck with ADT for 3 years after radiation without taking a break. But by taking a break, you selected for the the most resistant cancer cells, which is why your PSA rebounded so quickly.

Now, there's nothing to be done but to intensify hormone treatment with ADT+abiraterone permanently.

[R1166 in reply to Tall_Allen]

Thanks Allen, the diagnosis and treatment plan was never meant to be curative (was defined palliative from the beginning). The infra/para aortal mets were not treated (possibly there were too many?) but the radiation was to whole pelvic area .

The continuous ADT period has been 2.5 years.... would the 3 years you stated have made a noticeable difference ? Does this PSA rise means I won't be able to take another holiday, even if PSA drops again quickly to <0.02 ? 🙏✌️

[Tall_Allen in reply to R1166]

According to the STAMPEDE trial, 3 years of ADT with 2 years of abiraterone provided a benefit when there were pelvic lymph node metastases.

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

Here's info to consider for intermittent ADT:

prostatecancer.news/2023/04...

[cesces]

Sure seems like you have a serious doubling rate.Maybe you should investigate bipolar androgen therapy.

[Dont08759]

I went on my ADT (Lupron) vacation a few months ago. I was told I would resume Lupron + abiraterone when my PSA = to 50% of the value when I went on Lupron 21/2 years ago or 3.6 from 7.1. With my PSA 0.03 and T=5, Aetna Medicare Advantage denied a PSMA scan…

[Hawk56]

Here's my clinical history. I did enjoy an almost 4-1/2 year treatment vacation. Alas, all good things come to an end. My medical team and I actively monitored my PS,every 2-4 months. We had decision criteria, three or more consecutive rises, image between .5-1, then decide. As you can see, my PSA finally did, we imaged with Plarify, back on treatment, SBRT and ADT, though this time Orgovyx which so far has not had the fatigue side effects of Lupron though hot flashes and genital shrinkage, sigh...

My radiologist handled the SBRT, my oncologist was initially wanting to do 24 months of Orgovyx and Xtandi but at our 1month (well, six weeks) consult wanted to see the response from just the Orgovyx. When he saw that, he wants to wait for our next consult at the end of July, if PSA drops again, he may continue Orgovyx, consult again at six months, then look at the clinical data and decide to continue, discontinue....He says the level of my response may indicate like before, a very durable remission.

His concerns are the SEs, particularly of adding Xtandi. We did discuss the Embarq trial. It's always a balancing act, treat too little, treat too much...At first when he talked about 24 months of Orgovyx and Xandi he said it might offer a "cure" given the lone met on the Plarify scan. I smiled and said that would be great but look at my clinical history, the data doesn't support that! I told him I was ok with managing this as a chronic disease, using a 3-5 year time period to frame treatment decisions..

Given the clinical data you presented the forum, not treating is likely not an option. I would consider imaging, using the results to inform the treatment decision, possible doublet or triplet therapy, here's one link, you can find others - cancertherapyadvisor.com/ho....

Kevin

Treatment Summary

[nextphase]

For myself I'm 16 years out post op. I have been on lupron now for over two years. My last three psa tests have been at 0.02. I asked my oc about coming off of ADT and he suggested that I should stay on it because it's working keeping things at bay for now. He feels that if I go off the T is just going to fan the flames. Time will tell. Good luck.

[StayingOptimistic]

if it was me, I would go back on ADT immediately and add additional second line AR. I went back on ADT 2 weeks ago.

[MateoBeach]

I would push for a PSMA scan now as it can be positive at your current PSA level and could indicate significant potential for Lu-PSMA treatments. Then would restart ADT with abi and not wait longer with the rapid PSADT.