18 vs 24 mos ADT

[Oceankayaker]

I was dx in Oct 2021 with Gleason 8, t3a, N1,M0 grade IV PC received 39 radiation treatments after3 mos of firmagon and Zytiga. PSA is undetectable. MO has agreed to 24 mos ADT since I had a clean bone scan originally, lymph nodes do not show disease now. Tumor was outside prostate on MRI. The Predict-RT trial shows promise that there is no significant difference in outcome for 18 vs 36 mos adt, but trial is not over yet. What have others experienced with ADT duration?

[Tall_Allen]

PREDICT-RT is testing 12 months of ADT vs 24 months of ADT in men with low Decipher scores; and 24 months of ADT vs 24 months ADT+Erleada in men with high Decipher scores.

Maybe try to get a Decipher score to help you decide.

[Oceankayaker in reply to Tall_Allen]

thanks I stand corrected. The article I was using discussed a number of trials that I mixed trial and results.

[Jbooml in reply to Tall_Allen]

I’d had it with Zytiga…after near 4 years I’m throwing in the towel. I’ve had just too many arrhythmias lately. It’s scary, my faith has been shaken after my wife’s death last month, watching her miserable suffering after repeated failed treatments has me opening my mind to finding alternatives paths. No question ADT has taken me from death sentence to a near normal life but data now points my compass otherwise.

We are an aggregation of hopes and fears and mine are leaning toward a new chapter favouring the former.

[Tall_Allen in reply to Jbooml]

I'm sorry about your wife. Now is probably not the time to make life-changing decisions.

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

May your dear wife rest in Peace.......

j-o-h-n Saurday 07/08/2023 1:10 PM DST

[Oceankayaker in reply to Tall_Allen]

it seems to me most of these studies, if not all look at high risk localized disease, meaning contained within the prostate. Per definition, I have high risk regionalized disease meaning two nodes were involved and a couple extaprostatic protrusions. Therefore it may be a hard sell to get MO to agree to 18 mos. It because I am 25 yrs post by-pass and have arthritis with 2 joint replacements at this point I’m more concerned about advers effect of ADT on those two health issues than I am about recurrence of PC.

[Tall_Allen in reply to Oceankayaker]

There is a trend toward more clinical trials that include men with positive pelvic lymph nodes (N1 M0). STAMPEDE is the one we have results for, and it says there is a benefit for 3 years of ADT and 2 years of abiraterone. Unfortunately, trials among high risk (N0 M0) patients don't apply to you .

[VCinTx]

I was told that I should do 24 months. I dropped to undetectable PSA after 2 months on Lupron. I did my research and I told my MO at 18 months that I wanted to stop. I then started TRT and I feel great! No significant rise in PSA in one year.

[Hidden in reply to VCinTx]

do you think there is any possiblility you were not metastatic

[VCinTx in reply to Hidden]

I had one lymph node biopsied and it was Gleason 6 also. I think that the ADT and radiation have done their job.

[Hidden in reply to VCinTx]

So you had a lymph node biopsied at the time of radiation or maybe before? So you had radiation to the prostate and radiation to the pelvic area as a whole? I am just wondering why they would biopsy a lymph node. Maybe it was swollen? Anyway I guess it is only peripheral to the main question about using TRT after PCa treatment.

[j-o-h-n]

Long ADT --------- worked out so far...........(and always remember - heads up in the kayak)....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 07/08/2023 1:14 PM DST

[Don_1213]

It's a bit of a craps shoot. You can find papers with results indicating that 18 months is not inferior to 24 months and papers that find 24 months is not inferior to 36 months.

I think a decision might take into account other confounding factors - such as circulatory/cardiac issues, arthritis, osteoarthritis, bone-calcium numbers.

I was diagnosed as a G10, N0,M0 - nothing outside the prostate (with the tests available at the time of diagnosis) - a fairly low PSA (around 3.2-3.4 when prior to that I'd always been below 1), and a nodule felt on DRE. Treatment was ADT (Lupron) started 2 months before 45 radiation treatments (83Gy) and ADT continuing until I had a total of 18 months. T was basically zero while on ADT, and PSA undetectable (on standard tests, ie <0.1).

After about 6 months off ADT, my PSA was between undetectable and 0.1. At that time I stopped taking finasteride (taken for hot flashes - but causing moobs) - my T started climbing, and my PSA basically doubled - expected when coming off finasteride. It was now between 0.18-0.22. It's now hung around 0.22 for the past 2 years. It goes up and down a bit (+/- 0.02) - but not any worrisome amount. My T is now normal for a 77 year old man (me) at around 350-380. All the numbers have been very stable. I have 3 doctors writing me PSA test scripts so I get tested about every 6 weeks or so.

So that was with 18 months vs the originally suggested 24 months.

I consider myself in remission. Two MD's told me "cured" - but I think saying that with PCa is presumptuous. I think one can only say that if you die from something else. If I live long enough it won't be a surprise to see it come back at some time. The 18 months of ADT did a job on my body - it felt like I aged about 10 years in a year. Covid and it's shutdown didn't help. Getting back to where I was has proven impossible. I have 5 stents and fairly bad neuralgia in the legs making it difficult to walk or stand around. I blame a lot of that on the ADT.

The arguments of 12 vs 18 vs 24 vs 36 are probably endless since someone who does well on 36 months might well have done just as well on 12 or 18 or 24 months. All you can go on is the survival rates (which don't differ much at all for 18/24/36) and recurrence (which does differ a bit - not hugely - for 18/24/36).

Long ADT worked for j-o-h-n - would shorter ADT have worked as well? We'll never know.

Each person's disease is unique to them, as are comorbidities that may be a factor in the decision of how long (or even "if") ADT is done for. I figured I'd give details on my disease/treatment/results in case there is a similarity to what you're experiencing.

Good luck with your decision - and I realize it's lots easier to say than do - but don't look back at the decision with regret or second-guessing. Once you make the decision it's done and no use worrying about it in the future.

[Mgtd in reply to Don_1213]

Don you last paragraph is true of this disease and like in general. Moving forward is the key in both. Looking back just waists energy and does not help.

[Passisa69]

I have been having Zytiga now for 14 months , it has kept my PSA down to .o4 it has been a life saver

[bean1008]

I am nearly 66yo and at 30 months now with Lupron and Abi. My second month I was undetectable and have remained so. What I’m getting out of this is that I should stay on them until a) they start to fail or b) I just can’t stand the side effects (fatigue mainly) anymore. I have my bad days but other treatment options sound unpleasant or worse. Staying the course.

[alephnull]

I have been on some form of ADT for 9 1/2 years. It took (7 1/2 yrs Lupron, then Orgovyx my current one) 8 years for me to go CR. I was near undetectable the whole time until CR.

I'm now on ADT plus Xtandi, I much prefer just ADT.

ADT made me sluggish and tired.

Xtandi doubled those two, and added gave me brain mush.

But, Xtandi sent me to the undetectable ranks.

[DJBUNK]

In 2019 was a G9, T3b N1M0. Decipher came back as high risk (0.71).

Eight months after RP in 2020, my PSA became detectable (barely at 0.03) so I began adjuvant SBRT and 24 months of ADT. I had a second and third opinion from Cleveland Clinic and Johns Hopkins that confirmed the same treatment plan.

My last ADT injection was 16 months ago and so far, PSA is still undetectable.

[Oceankayaker in reply to DJBUNK]

thank you for your story. I’m hoping to get a Decipher test to aid in decision to end at 18 or stay course at 24 mos.