Vacation from Lupron/Zytiga - Temporary or Permanent!

[groth12345]

I have been on ADT (Lupron/Zytiga) for 2.5 years. PSA and testosterone immeasurable currently. Looking to go on "vacation" from meds.

History:

Gleason 8/9 with a PSA of only 1.89 (on Finasteride). CT/Bone scan did not show any definite metastasis. PSMA PET showed "possible" metastasis in 4 spots around ribs. "Indeterminate" and "suspicious" was the radiologist's wording. Treated aggressively due to possible Stage 4. Had 25 rounds radiation of prostate for primary tumor last year.

I've been recently consulting with MSK as a 2nd opinion. They typically allow ADT "vacations". Most people on this forum do not recommend it. However, MSK are saying that there was no definitive determination that I have any metastasis. But before going off ADT, they recommended radiation of the pelvis/lymph nodes (since one was enlarged).

I just started 25 rounds of radiation to the pelvic region in hopes for a potential cure and to go off the ADT meds.

After the testosterone recovers, what should my PSA range be? At what point (PSA level) should I get immediately back on ADT?

Steve

[Scout4answers]

Following your progress with interest I have similar DX about 6-9 months behind you.

I was not aware that one could have radiation treatment a second time.

I had radiation to prostate and Lymph node chain on the first go round.

[groth12345 in reply to Scout4answers]

I was originally diagnosed Stage 4 and MSK only recommended prostate radiation. Not sure why they didn't include lymph node chain then. I'll keep you posted.

[Tall_Allen]

I assume you had the prostate irradiated last year and your pelvic lymph nodes this year? You didn't mention that you had some positive lymph nodes on your PSMA PET scan, so I'm confused.

If you don't have any metastases, you had potentially curative radiation. With curative radiation for high risk PCa, one does not have vacations, one has a limited term of hormone therapy and that's all. If you had positive pelvic lymph nodes, the hormone therapy should be 3 years of ADT and 2 years of abiraterone.

Your initial PSA was very low - and bears further investigation, IMO.

[Hidden in reply to Tall_Allen]

He had bone mets.

[Tall_Allen in reply to Hidden]

No, he says they were not bone metastases.

[Hidden in reply to Tall_Allen]

Yeah, weird wording in his past PSMA!

[groth12345 in reply to Tall_Allen]

Thanks. PET scan showed mildly active right lymph node. It also showed a few low volume spots on the ribs which were deemed indeterminate.

Yes, I did have the prostate radiated last year and the pelvic lymph nodes are being radiated now.

I've been on ADT for 2.5 years and Zytiga for 2 years. MSK recommending 2-3 more months of ADT after pelvic radiation since they want an overlap.

[Mormon1]

Stay on Zytiga

[groth12345 in reply to Mormon1]

Zytiga only stops testosterone from adrenals. Lupron is the main castrate drug.

[EchoII]

Probably no definitive answers to your questions. I have metatastic hormone sensitive prostate cancer. Had a prostectomy. 12 years ago at Hopkins. After s fee years psa went up and scans showed cancer all over the place. On ADT and zytiga for several years after psa went up. Got down to undetectable for a year. Took a nice 9 month vacation from everything. Now psa is rising so going back on the adt and zytiga. Being treated Georgetown Oncology. You never know. A close friend had the same story as me. He is now dead from the cancer. I am not worried because i was dead for millions of years and I will be dead again for millions or billions of years. Life is just a blink of light in the eons of darkness.

[groth12345 in reply to EchoII]

I think the key is close surveillance. Currently checking psa monthly.

[j-o-h-n]

So tell us your age..... and who's treating you MSKcc? Thanks.

P.S. See my "survey" post results below regarding how members feel about ADT vacations.

RESULTS:

86 No - VALID responses (55.5%) - no vacation

69 Yes - VALID responses (44.5%) - yes vacation

155 Total VALID responses

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/11/2023 10:14 PM EST - Honor our Veterans.

[garyjp9 in reply to j-o-h-n]

Given Tall Allen's response above and John's survey results, what are people talking about when they refer to ADT "vacations" ? Are they in a circumstance where they are essentially on ADT for as long as possible, with no "curative" potential?

[j-o-h-n in reply to garyjp9]

Damn it..... I knew there was a fly in my ointment somewhere......Thanks for finding it.....Back to the drawing board........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/11/2023 11:09 PM EST - Honor our Veterans.

[groth12345 in reply to j-o-h-n]

I'm 71. Diagnosed at 69. Treatment is at URMC Rochester NY. MSK second opinion is Dr. Michael Morris. Thanks for sharing.

[j-o-h-n in reply to groth12345]

Thank you for your response....... Well you're in the best of hands with Dr. Morris. Stay well and keep plugging away.....God Bless you and all....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/12/2023 1:33 PM EST

[groth12345 in reply to j-o-h-n]

Thank you.