What do you want to know about Androgen Deprivation Therapy (ADT, hormone therapy)? I will record a video interview with the massively knowledgeable researcher Richard Wassersug, PhD, and his colleague and coauthor, Lauren Walker, PhD. Please post a reply with topics you want me to cover. And, consider clicking the link below for your Prostate Cancer video channel subscription to watch over 300 videos for free.
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With the advent of the PSMA PET scan is there an argument to be made that perhaps shorter courses of ADT should be considered for locally advanced vs. the “belt and suspender” approach of 2-3 years of ADT?
How does the use of estrogen as ADT work as opposed first and second line Testosterone suppressors/ reception blockers. Specifically, we know that second line drugs block inhibit absorption of testerone at the cell level or prevent its production at the enzyme level. We know the adrenal glands produce low levels of testosterone and that's often why both Lupron and a second gen ADT is prescribed. How is Estrogen different and is it still viable following bilateral orchiectomy?
Please ask him to break down ADT (GnRH agonists and antagonists) side effects by the approximate percent of men they occur in and what the percents are for adjuvant use with radiation (4 months-3 years) vs permanent, long-term use. I think there is sometimes confusion over what side effects to expect with short-term vs long-term use.
When to start ADT if in BCF but with clear PSMA-PET scan? Are there any new ADT drugs that show superiority?
What is his opinion on mitigating ADT side effects with estradiol patches?
Risk Benefit of ADT and incidence of Neuroendocrine conversion. Especially in BRCA positive patients.
are efforts being made to eliminate side effects from ADT?
I 2nd the probabilities of various side effects and the way in which those probabilities may change as ADT duration increases from 4 months upward. Don't know if his expertise, but success rates for different durations of ADT with radiation.....for Gleason 4+3, 4+4, and Gleason 4+5 and 5+4 ?? What duration achieves 90% of the benefit achieved with 24+ months of ADT? 12 months for 90% efficacy? more or less? Some of us wold risk that slightly lower efficacy for the benefit of shorter ADT!!!
I am 60 and have been on ADT for almost 5.5 years. Great response. Bone mets no longer visible. PSA and testosterone are both undetectable. Healthy, other than typical ADT side effects. Oncologist believes I have a few more years of life yet.
Bone density scans show developing osteopenia. I would like to know what I can expect over the next few years with continued ADT use. How much longer can the ADT keep my cancer suppressed? How likely am I to experience additional bone degeneration, organ damage, etc.?
These are my questions too.
great news!!
Can you tell me with these great stats why does the Ocologist believe you have X amount of years left? I often wonder why if everything is under control why is it stated that still this prick cancer will take our lives?
If after 24 months of (adjuvant) ADT testosteron is back rather quickly, is that a good or a bad sign (for the cancer)?
Sure. Have him address;
1 Effects on nocturnal erections
2. Impacts on Penile tissue health.
3. Shrinkage of penis
4. Development of Venus leak
5. Long-term impacts on libido even after cessation.
6 model for predicting impacts of all of the above, on a timeline; at what point do these impact become irreversible
7 When should men consider a IPP penile implant if they are going to use ADT long-term. What criteria, test or milestone is recommended to help me and make the decision.
8. why aren’t any of these impacts if present discussed with patient before use of ADT.
For Decipher testing if the statement made by the podcaster in this interview is correct? Is there a matrix published, within the Decipher testing protocol, that will predict if men will respond to ADT? If so, can this be used to spare men ADT side effects, should they be non- responsive? See;
Min 16:03; Best predictive value for test
-determining if the use of hormone treatment will be effective
- sparing men the adverse impacts of ADT when it will not provide additional survival benefit
please discuss the effect of long term ADT on the brain
When are you doing the interview(s) and when will they be posted?
Darryl, would love to have a discussion on supplementing testosterone and prostate cancer. New thinking suggest there is no increased risk of recurrence or progression with T therapy in men previously treated for prostate cancer.
Current research on BAT, results and medical acceptance - are any valid studies being done, and is the needle moving in the medical community?
Are there less SE's with an orchidectomy as opposed to ADT?
If PSA starts to rise again after a long vacation from ADT in which PSA remains undetectable for over a year, at what point should ADT be resumed? Is there any research to support restarting when PSA reaches 1.0 or 2.0 versus 10.0?
How do the “lutamides” stack up against one another in terms of effectiveness, side effects, or any other meaningful metric?
Thanks Darryl. I would like to know about ADT meds inducing transition from PCa to neuriendocrine PCa (NEPC). So many of us are on Zytiga/Xtandi. But while I had a low PSA for years, I got a sneak attack of NEPC. I had no idea this could result in the transition. Apparently my MO was aware it was a rare possibility- so rare, we weren't looking for it. (I just saw TylexGP asked the same thing.)
I think Dr. Wassersug is very interested in the final results of the STAMPEDE/Patch trial. Has he heard when these are due to be presented? I guess he is in contact with Prof. Langley and can tell us when these are expected to be published.
I have been on ADT for 2.5 yrs, Gleason 4+5, metastatic. Along with the ADT (degarelix + enzalutamide) I was given a monthly infusion of Zometa (bisphosphonate), which I stopped getting 9 months ago after apparently developing osteonecrosis of the jaw (ONJ). I am now on Orgovyx + Nebeqa (darolutamide) and recently started taking a 1 % estradiol gel. Does Richard believe that the estradiol can take the place of the Zometa infusion to shore up the bones.
I am interested in a doctors thoughts on ADT SE's refering to sexual, psychological, social, relational consequenses. I often feel reduced to an arena of lab tests, scans, surgery, radiation and drugs.
How long will acceleration of bone loss continue after ADT ends? Likewise, sarcopenia?
There seems to be a plethora of drugs one can use for ADT from what I can tell from the posts on this website. Maybe a discussion of when to use what and why would be helpful, if there is some reasoning behind the drug selections. 🦊
Once ADT has been started for hormone sensitive, recurrent PCa, and the PSa comes down to undetectable or very nearly so, can the dosage of ADT and Xtandi be reduced and the PSA and testosterone levels monitored.
Did you ever record interview? How can I find it?
What they don't tell you about Androgen Deprivation Therapy (ADT, hormone therapy)
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Exercise in Patients With Prostate Cancer Undergoing Androgen-Deprivation Therapy
Intermittent Androgen Deprivation Therapy : Redefining the Standard of Care?
Neoadjuvant Androgen Deprivation Therapy in Prostate Cancer (with surgery)
A positive about hormonal therapy?
