ADT IS DONE. NEXT?

[rfgh20]

Lupron and Zytiga will have completed 2 years of each in June. I've read some continue Lupron for 3 years or longer. How do you know how long to take? Monitor testosterone and PSA how often? 2 or 3 months?

[Atdabeach]

I'm in the same boat -- 2 years will be done in July -- so very interested in the answer. Looking forward to having my manhood back, at least for awhile ...

[MJCA]

Hi,

This round, I have been on Lupron going on six years. At that time, I was diagnosed castration resistant. After a few years on Lupron, I asked my MO if I am castration resistant, why do they continue to keep me on Lupron?

I was told that even though the Lupron no longer has any affect on my PSA, it continues to keep my testosterone levels low.

I hope that answers your question. Of course, my libido died years ago.

Best to you

[rfgh20 in reply to MJCA]

Thought testosterone being low kept PSA low? If testosterone resistance, what difference does it make?

[Ahk1 in reply to rfgh20]

Castrate resistant means: low T and psa is rising.

[MJCA in reply to rfgh20]

Testosterone is what feeds prostate cancer. So, theoretically, by lowering testosterone is starving the cancer - keeping it from spreading faster.

[dhccpa in reply to MJCA]

TA can explain this better, buty understanding is that when Lupron "stops working," it actually is continuing to work against many/most PCa cells; the next step of treatment is to fight those PCa cells that have become resistant. Over time, Lupron works against fewer and fewer cells, but it is an ongoing process.

That's my understanding; others may have a different take.

[dhccpa in reply to MJCA]

TA can explain this better, but my understanding is that when Lupron "stops working," it actually is continuing to work against many/most PCa cells; the next step of treatment is to fight those PCa cells that have become resistant. Over time, Lupron works against fewer and fewer cells, but it is an ongoing process.

That's my understanding; others may have a different take.

[RoseDoc in reply to dhccpa]

Your understanding is correct. Much like using antibiotics, after a period of time the organism shows resistance, mainly due to the fact that the organisms have mutated and those with that mutation are resistant to the antibiotic and thrive, so another stronger antibiotic is used or a combination. PCa cells develop the ability to synthesize testosterone internally and, therefore, become less dependent upon testosterone in the blood stream. It is a bit more complicated than this but the concept is there.

[dhccpa in reply to RoseDoc]

Thanks

[Tall_Allen]

The STAMPEDE protocol for men with pelvic lymph node metastases was 3 years of Lupron and 2 years of Zytiga.

[rfgh20 in reply to Tall_Allen]

That's what I thought. MO'S saying 2 years.

[Tall_Allen in reply to rfgh20]

email this to him:

"ADT was given for 3 years and combination therapy for 2 years"

ncbi.nlm.nih.gov/pmc/articl...

[rfgh20 in reply to Tall_Allen]

Thank you! You tha man!

[Cyclingrealtor in reply to Tall_Allen]

Are you aware of any updates?

I'm in the same boat in June/ July and will be 2 years adt and 18 months of abiraterone and prednisone.

[Tall_Allen in reply to Cyclingrealtor]

There are no updates. That is the most recent published data.

[BluesmanNick in reply to Tall_Allen]

TA could you please outline the recommended next steps for us? Is it just "test PSA and T" every three months, until PSA goes too high? And how much is too high?

Thanks

Nick

[Tall_Allen in reply to BluesmanNick]

Nick, please start a new thread- so as not to get your stuff confused with the OPs.

[BluesmanNick in reply to Tall_Allen]

No worries. I was seeking some further clarification on what I thought was an unanswered part to rfg20's question: (ie "Monitor testosterone and PSA how often? 2 or 3 months?").I will start a new thread.

[btca in reply to Tall_Allen]

Thank you TA for the information. I have been on Lupron, casodex 3+ years, (ADT) ,PSA has been .01- .02 , .03 latest test. I had one faint marker on a pelvic lymph node to faint for the radiation oncologist to attempt erbt Dec. 2020. So what should I expect now? I am 80 1/2 , reasonable good health now.

[Tall_Allen in reply to btca]

Let's not hijack the OP's thread. Please start a new thread.

[Hawk56]

Well, my answer, study of one, I've done ADT twice, 1st in Jan 17 as part of triplet therapy. Dr. Kwon's plan was 24 months, add Zytiga if PSA was not undetectable pr resistance set in. PSA did become undetectable, stayed there, I saw some data saying 18 months was enough, Kwon acquiesced and we stopped the Lupron at 18 months.

That triplet therapy brought almost 4-1/2 years off treatment. We will never know what the additional six months would have done, possible benefit, longer progression free survival, risk, becoming resistant.

While off treatment labs and consults every 2-4 months. In March 2023 our decision criteria was met, three or more consecutive increases in PSA, with PSA between .5-1, we imaged with Plarify, a single PLN shows on the scan, we do SBRT to that and add 12 months of Orgovyx. I will say when I first met with my oncologist he advocated 24 months of Orgovyx and Zytiga, saying it was potentially "curative." I said we are not curing this, we are managing it. He pondered for a minute and said, ok...

My oncologist hold on Xtandi pending PSA dropping to undetectable in first three months, it does. At the 12 month point radiologist is comfortable stopping, oncologist ponders six more months, then says ok to stopping at 12 knowing that as a patient I will adhere to labs and consults every three months. We do change our decision criteria, radiologist feels given my clinical history, particularly PSADT, we can image at .4.

So, while data from clinical trials is useful, I have chosen (in concert with my medical team) a more individualized approach. Right or wrong, we can't say since we can't clone me and run a parallel study.

Data such as NCCN guidelines and clinical trials are useful as guidelines in pondering one's treatment decision. There is science behind those. Still, as I discuss with my medical team, there's the art of applying science to the patient.

Kevin

Clinical History

[SteveTheJ]

If you have stage 4 prostate cancer, expect to be on these medications for as long as you live. I've taken Lupron since March 2020, and counting. Hope for the best.

[TaylorMill]

I can't answer your question. as posed But I can say that my Med Oncologist kept me on both Lupron and Casodex for a little over 4 years.

The "why" as I heard it from her was that (1)the ADT started out effective and stayed that way the whole time. (2) It caused me NO significant side effects (3) During that period a few studies suggested longer terms could conceivably bring a "cure"

Yes that "cure" word was actually used; however, I told her I thought that seemed wrong. She said "yes" she would not use it herself but rather has considered me in remission for the past two years,

Because our circumstances have both some similarities but also differences, here is some context.

Upon my first turning 65 and on Medicare, i did a full physical which revealed a number of issues - type 2 diabetes, a PSA of 52, plus an abnormal EKG which resulted in extensive cardiology tests.

Regarding the PSA of 52, my Urologist did his own follow up diagnosis including old fashion zapping (prostate biopsy) in his clinic. (This was 6 years ago - he may have done some other tests that are more mainstream now) Biopsy had multiple core with Gleason 6 or good 7 with one core that was bad 7. He strongly advocated RP and strongly discouraged any form of radiation as the primary treatment. Post RP biopsy confirmed spread to one tested lymph node and also seminal vesicles. However one major positive outcome was that post op PSA was ,06

[lookout4 in reply to TaylorMill]

Taylor, this is Steve, like you I have type 2 diabetes, and some heart troubles with my PCa stage 2.

Q), what came first, the diabetes or the PC?

[TaylorMill in reply to lookout4]

I don't think I can give you a good answer but here goes --- the circumstances are that the diagnoses were at the same time upon a first Medicare physical. There had been perhaps 10 years or more since any prior comprehensive physical. There had been elevated blood glucose previously but only a borderline range for diabetes. I personally have never heard of a connection between diabetes and PCa. It might be an interesting question for me to aske my oncologist but I won't see her for several more months. My primary care doctor monitors/treats the diabetes, med oncologist monitors/treats the PCa and a cardiologist for the previously noted heart issues. It seems the docs likely don't see any relationship either or simply just each focus on one of them.

[j-o-h-n]

Take the meds until you can't take them anymore............(catch my drift?)

Good Luck, Good Health and Good Humor.

j-o-h-n

[lookout4]

Thanks