I am due to get my third 6 monthly dose of Lupron injection in late May. I plan to travel during that time. Is there any harm if I should postpone the injection date by 2 or 3 weeks beyond the 6 months dateline?My PSA reading is currently below 0.1 ug/l.
Secondly, I am contemplating going on ADT vacation at the 18 months mark. Is it advisable?
Thank you for any advice.
Yes, there is harm in delaying.
Here's info on iADT:
prostatecancer.news/2023/04...
I add my vote to that of Tall_Allen.
Think about it - your ADT is suppressing your testosterone. This means that all those greedy little prostate cancer cells, which are sort of asleep now, are not getting the signal they desperately need - to wake up become active again. And to do their prostate cell business.
But if you delay or even worse take a holiday that means that your testosterone will likely go up again. How fast I don't want to find out myself.
And if and when testosterone does go up again, then your prostate cancer cells will wake up again too. Every day they're just waiting for big T! To start really living again! To grow! And to start dividing again. And travel. And then the host, you and I, are closer to the end.
All this is all reasonably well known. Nevertheless, the "I'd like to go on an ADT holiday for a while" dialogue pops up frequently on this forum. For prostate cancer fighters though, the ADT regime is forever.
Are you saying that 2 weeks without lupron will harm the control of the cancer, when the recovery of testosterone in old people is slow? I had a 6 months lupron shot in 2016, never got another one and my testosterone is less than 12.
Everyone is different in testosterone recovery. It's not a gamble anyone should be advised to take, especially since you have no reason to promise such a dangerous thing.
This is not intermittent ADT and letting the PSA go up to 20. This is a 2 weeks delay in a lupron administration.
I understand that. He was also asking about iADT. I answered that both have risks.
The link you provided was about return to baseline testosterone. Androgen receptors are activated by any T level above 20 ng/dl. That could easily occur on a 2 week break.
The lupron injection does not stop working after exactly six months. You can delay that.
The recent Embark trial showed good results for intermittent ADT. urotoday.com/conference-hig...
Thanks GP. I have read now the important article you shared on new interpretation of results of the Embark trial, which includes the comments by Dr Stephen Freedland.
I noted that the insights from the trial are derived from the use alone or in combination of enzalutamide and leuprolide specifically.
PCa is so complicated. And it seems to me that there is a temptation to generalize from a very specific - and welcome - trial result. So that when one is overwhelmed and crushed by the ongoing effects of ADT and wants to take a holiday because "X", it's easy to conclude that there is no risk associated with that decision.
In the Embark trial, if I understand the enrollment criteria correctly, everyone had had either EBRT or prostatectomy. So I don't think the easily applies to me or anyone with my situation. My diagnosis almost 2 years ago now was too late - and fortunately and many ways to - I have had no radiation or surgery.
And further my ADT is an androgen antagonist every 28 days, with different pharmacokinetics and biochemistry than 90-day agonist injections.
Interruption of ADT is interesting in different planned circumstances especially around BAT or when is trying to interrupt selection pressure. But what I take from Tall_Allen's comments is that there are risks in a casual ADT holiday.
As everyone keeps pointing out, every individual is different. And testosterone may come back faster or slower depending. And one's prostate cancer cells may be more or less sensitive to very low levels of testosterone. An ADT holiday is not something to take lightly.
John had his prostate radiated, so he could follow the Embark trial. There has been no trial that significantly showed that intermittent ADT is inferior. E.g. these trails: pubmed.ncbi.nlm.nih.gov/235... pubmed.ncbi.nlm.nih.gov/192...
Those trials were from 2009 and 2013! The one from 2013 includes the statement "we cannot rule out a 20% greater risk of death with intermittent therapy than with continuous therapy". Tall_Allen's original reference above to his full review of all the studies is great.
They also were non-metastatic via CT and bone scans. Which is why the MFS numbers are highlighted in the EMBARK study. They also, for the first time, showed mono enzalutimide is superior to ADT.
I must be misunderstanding...number 5, it looks like for metastatic castrate sensitive at 10 year followup the iadt and cadt showed small difference?? And mortality increased 10% due to cADT?? I'm confused
Sorry -that was my error - now corrected, thanks. Mortality increased 10% due to iADT.
Thank you for the clarification.
You are 72 years old, the recovery of your testosterone most probable will be very slow, if it recovers at all. You can wait 2 or 3 weeks. Enjoy your trip and before leaving consult with your MO.
anecdote, not evidence. Sample size of 1.
Reading your history, it appears as though your testosterone had recovered after going off the initial ADT (I surmise) you took as adjuvant to radiation. You are close to my husband’s age. It took his testosterone 6 months to become measurable after stopping adt. Several times, while on ADT, he increased the dosing interval by a month due to travel and he didn’t have an issue.
Hey John.......... ask the doc........ it's as easy as 3+4 =7....
Good Luck, Good Health and Good Humor.
j-o-h-n
Thank you all for your responses. We all know that docs are not the most well informed nor keep up to date with the latest developments in PCa treatments. That's the reason I'm posting here for your advice.WRT iADT, my MO did suggest minimum 2 years for ADT. That's probably what I'll go for.
Regarding delaying the ADT jab, I'll put it off a week or 2 at most to reduce the risk.
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