Criteria for "my ADT has stopped working and we have to move to another"

[jackwfrench]

Hello - So my third post ADT initiation (Lupron+Abi) PSA test is coming up and since it was <.1 six weeks ago, I asked how the criteria of “has stopped working” works -to my Hopkins MO and I got this -

“We want to declare a therapy no longer effective when PSA is clearly going up.  We look for 0.3 to 0.6 among the patients who are scared. 2.0 to 4.0 among the relaxed. We should wait for a PSA doubling time of less than 9 months. In either case we don’t care about number 2 or 3 places after the decimal. Anything less than0.3 is not useful unless looking for relapse after radical. Remember NCCN protocol is to start enzalutamide or apalutamide if PSA clearly rising.”

Then I was shocked this week to read that SOC has only a 20% success rate! Do any of you more experienced gentlemen have any observations for me? I certainly don’t know whether to be scared or relaxed! Thx

[Tall_Allen]

That's a very good answer he gave you!

IDK what you mean by "SOC has only a 20% success rate." Would you please explain what you mean by that or provide a reference?

[jackwfrench in reply to Tall_Allen]

Sorry TA it was in the midst of some trial I was reading yesterday, talking about the success rate of SOC treatment for metastatic prostate cancer as being only 20% without any other context. Had never seen it stated like that either! May not be exactly right but to me it does point out how I need to consider other options.

[Tall_Allen in reply to jackwfrench]

I have no idea what that means, and it sounds like you don't either. What trial? What does success mean? How did they measure "success" and over what time frame? I'm sorry to be blunt about it, but instead of it showing that you should "consider other options" your vague reply only shows that you don't know enough about how to read a study to make any inferences based on what you read. Perhaps discuss it with your doctor so he can explain what you don't understand.

[jackwfrench in reply to Tall_Allen]

Okay well the trial was definitely not to assess SOC. It was simply a passing statement in the text by the writer while pointing out the importance of alternate therapies. If anyone else runs across any real stats related to SOC success rates I would appreciate that sharing. Thx.

[Tall_Allen in reply to jackwfrench]

What does "success" mean?

[jackwfrench in reply to Tall_Allen]

I'll try to find it again and write the author when I have time.

Thanks for that Triton 2 on olaparib on my CHEK2, my MO says its relevant for me but only after several other therapies don't work.

[Rolphs in reply to jackwfrench]

Wrench: I have CHEK2 mutation also. If/when I become CR I will consider PARP inhibitors I guess. My MO is vague on what what comes next but next step could also be LU177. Have you looked at other options for our mutation?

[jackwfrench in reply to Rolphs]

No, but my MO will likely be wanting to go to chemo sooner in my journey because of it - he thinks it may be why I had BCR from RP in just 2 years.

[MoonRocket]

Well, given that stress is harmful to the immune system and relaxed is good for the immune system, I would choose the latter.

[treedown]

As for "We look for 0.3 to 0.6 among the patients who are scared. 2.0 to 4.0 among the relaxed."My insurance company made me "among the relaxed" and would not provide much in the way of scans until I hit 2.0 being the first recurrence. Then I had to have CT and Bone before they allowed a Pylarify (PSMA) scan. Even then it seems like Ingotnthe low priced version because they couldn't tell me any SUV on the mets they found.