Would I be on thin ice if I tried adaptive ADT this soon?

[jackwfrench]

After 6 weeks on Lupron and 9 days on abiraterone, my PSA was .1, and my testosterone was <1. This is within the criteria being used to start people on adaptive in this MCSPC Moffitt study with Jingsong Yang - (he says I can just follow the protocol without being in the study)pubmed.ncbi.nlm.nih.gov/363... MO thinks it risky and would stay with MDT treatment, but it feels like I am wearing out my body with these chemicals; and if this might push out my MCRPC timeline and my OS, why wouldn’t I try it? I have low volume PSA as it only peaked at 2.2. Thoughts are welcome -

[ARIES29]

They say PSA of 2 is the limit where one starts treatment so stay with it to 0 & good luck.

[Tall_Allen]

Very risky to do with a low PSA subtype. How many metastases and where are they?

[jackwfrench in reply to Tall_Allen]

one on right iliac, one at T10, some small spots on lower left sacrum as of 5/28 MRI

[Tall_Allen in reply to jackwfrench]

The risk is that you are allowing the cancer to spread and grow. I hope you doctor will complete a randomized clinical trial and not just treat patients per protocol. We learn nothing from his previous study on 16 patients because there was no control group- how would those patients have fared without his therapy? It only generates a hypothesis that merits further testing. Without a randomized trial, he is only feeding his confirmation bias - I hope you will raise this with him.

[jackwfrench in reply to Tall_Allen]

Yes. He admits no control group. I likely will go a second round of 3 month Lupron late Nov and continue with abi, and evaluate adaptive with Moffitt, and radiation possibilities with Dr Tran along the way.

[Justfor_]

With low volume PSA the deviations that you will get when employing an adaptive MED strategy will be lower than these of the average person. To correct on that you need to take more frequent PSA tests of higher resolution. I fear that single decimal place reporting isn't good enough. In my case (PSA was 7-8 before RP with GS = 4+5) I take monthly PSA tests and changed lab to a 3 decimal places reporting from 2 when started getting <0.01. All in all, adaptive needs fast and well calculated reactions. It isn't for the lazy or the sloppy.

[jackwfrench in reply to Justfor_]

Sounds like the gospel - since most insurance won’t cover monthly PSA do you use the at home tests?

[Justfor_ in reply to jackwfrench]

Public healthcare here (Greece) allows and reimburses quarterly PSA tests. The additional 2 in-between are out of pocket at 14 Euros each (15-16 USD)

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

Where are you located in Greece? Opa with Yi-a.................

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 10/23/2023 10:11 PM DST

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

Athens.

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

Well, "just for" informational sake (not that you asked), I think you know I'm an American/Greek. I've been to Greece on several occasions to visit my relatives. Well I remember my parents praising Greece and how beautiful it was, not any more. I despise graffiti, here or anywhere else. To me it's garbage for the eyes. Well Greece is loaded with it all over everything and it's political scribble (over beautiful marble).

Well, here is a something you might pass on to your relatives, friends and neighbors in Athens and which they can relate to:

One evening in Athens, Greece, a nun wearing her habit was waiting for a bus which happened to be 15 minutes late. She was found the next day at the bus stop, her body graffitied to death.......

Anyway I said my piece so I'll rest my case.

Καλή τύχη, καλή υγεία και καλό χιούμορ.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 10/24/2023 12:12 PM DST

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

Graffiti is at the entry level of the current deterioration scale. There are other more serious offenses that propagate freely. But, this forum is not the appropriate agora to raise such subjects. Lastly, I am old enough to know first hand that your parents were not BSing you.

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

You're absolutely correct........ I should have private messaged you instead. Sorry, my Greek temper genes blinded me.....As Alex the Great once said "If they don't have bread, let them eat Pita"....

Καλή τύχη, καλή υγεία και καλό χιούμορ.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 10/24/2023 3:14 PM DST

[Hidden]

Testosterone is ng/dL or nmol/L.?

[jackwfrench in reply to Hidden]

ng/dl