Intermittent Androgen Deprivation The... - Advanced Prostate...
Intermittent Androgen Deprivation Therapy : Redefining the Standard of Care?
This article was written in the year 2010.
I think the EMBARK trial provides the latest data on intermittent ADT:
Here is an article by Prof. Tombal discussing iADT and the Embark trial. nature.com/articles/s41391-...
Dr. Mark Scholz discusses iADT refering to the Embark trial: youtube.com/watch?v=k92ETEq...
This seems to be kind of ramdom. The MO is not quoting stats, he is throwing figures out there. 17-18 on years on iADT. Where did that come from? Among others. Also he mentions getting injections of T. That's BAT, not iADT.
He is not refering to the Embark trial only. I assume he observed patients who were 17-18 years on iADT. Because many patients have poor recovery of T after ADT, one can consider adding T to make the ADT break a difference to continuous ADT.
Above the image there is a link to an article by Prof. Tombal discussing iADT and the Embark trial.
It is an outdated article. We have a lot more info now.
prostatecancer.news/2023/04...
This appears to be a critical result; apparently undermining the concept of an "evolutionary" strategy, which originally felt intuitively satisfying:
"Any reduction of evolutionary selection pressure with iADT is balanced by the reduction in sheer numbers with sustained cADT. This is not surprising, given that intensive hormonal treatment with ADT and Zytiga, Xtandi, or Erleada has been proven to delay castration resistance in men who are mHSPC. "
Intermittent ADT becomes ever more popular with patients as more doctors are willing to participate. However, it is indeed true that the average man on ADT for longer than 6 months is who ‘vacations’ is unlikely to recover his testosterone to a significant degree in the time they have before ADT must be resumed.
Moreover, time until ADT is resumed generally becomes shorter with each subsequent vacation.
Often they either already had low T at baseline, they are elderly, or their overall health is poor. All the co morbidities that are either induced or exacerbated by testosterone suppression set the table for low chance of significant return of T when vacation time comes.
This is true even in relatively young men who did not have lengthy courses of ADT, if their health and habits are poor. Such is the hard reality of it.
Regardless, many men will report feeling much more energy and decreased side effects overall upon stopping- even if their T only rises to barely above castrate levels. Yet who is to argue? Placebo effect is a powerful thing.
Thanks for posting. It is indeed a hard reality but it has to be said. So many are desperate for relief from the sometimes horrible effects of the long term ADT keeping them alive. My guy has many times thought about this as his QOL has plummeted. We grasp at any chance to be again the person we once were. Everyone has the right to make the choice of course (and for some it seems to help) but in full knowledge of the evidence.
I’m sorry it’s been so difficult for your husband. If you’ve seen any of my posts on here you know they are mostly about exercise. I feel when it comes to ADT, it can never be talked about enough.
This very much includes in the context of intermittent ADT of course. Men who exercise tend to have higher T levels at baseline, recover faster after ADT is stopped, have longer vacations and much, much more.
Even when they don’t experience all this, their QOL is still vastly superior along the way.
Although ADT does keep the disease from taking over, sometimes for many years, it has 2 really heinous characteristics as you know. One is that it eventually stops working when the incredibly survival endowed beast adapts, and works around the drugs and their combinations.
How long this takes, so different in every man, is impossible to know. Until something new and better comes through research, ADT will remain a front line treatment, and we are basically helpless to this downside.
However, the other heinous characteristic is one we have quite a bit more control over: the heart health damaging, muscle wasting, metabolism slowing, cognitive decline causing, fatigue inducing (and more) side effects ADT is known for. Exercise is truly miraculous in its ability to minimize and even eliminate every one of these aging accelerators.
Sadly, some men are already somewhat overtaken by the time they are diagnosed, or become that way, making exercise difficult if not impossible.
This is not true for most though, yet statistically very few do it, with fatigue cited as the prime reason.
It can be overcome. Any exercise is vastly better than none if it can be done safely. There are the few guys that truly can’t do much, but far too many give up when they start to experience the swift and discouraging decline ADT can induce. Coupled of course with possible depression over the whole thing.
I empathize completely, but as long as I’m here I’ll never stop advocating for exercise! For me and so many others, it has been the key to tolerating ADT well-and likely delaying time to castrate resistance.
If your husband is bedridden or otherwise unable to move much, I am so sorry. Otherwise, he hopefully knows what more exercise can do for his QOL. Too many vaguely know it’s good, but actually have no idea about the incredible and far reaching effects of it.
Not easy, but profoundly worth it as I like to say. Whatever he is able to do, encourage more. Great luck to you!
Exactly correct, London441!
This was a great post! So many don't appreciate the importance of exercise.
Thank you for the reference. It's a bit old, but has a great review of ADT, for those who want to learn about ADT.
Good and very long, wordy study...will have to find time to read and not scan the whole document. But I picked up this while scanning it...
Article; "The potential patient candidate for IADT should have minimal metastatic burden, should be treated with at least 6 to 9 months of induction, and then be off therapy if the PSA level is < 4 ng/mL, and preferably < 0.2 ng/mL. Timing of off-treatment periods is variable. As suggested by recent trials, testosterone levels should be < 20 ng/dL for both continuous ADT and IADT, and T levels should be monitored frequently."
T levels over 32 ng/dL appear to be more prone to advance disease.
Article; "Overall, these researchers found that testosterone breakthroughs are both frequent and linked with PSA progression, with 32 ng/dL representing possibly the lowest serum testosterone threshold that carries a clinical impact.26 Specifically, patients for whom all 3 serum testosterone readings fell under 32 ng/dL had a mean AIP-free survival of 137 months, versus 88 months for those with any breakthrough increase above 32 ng/dL (P < .03).27 “To our knowledge,” the authors write, “this is the first report to establish a direct relationship between testosterone increases and AIP.”
Here is what I have found regarding IADT treatment...note that not mentioned in this article is that, the longer you are on ADT the less chance you have in recovering TET levels...if this is related to QoL then this is a major shortcoming of the study.
Additional Study; healthunlocked.com/active-s...
Reference at MIN 11:00 – TET Recovery. Majority (75%) of men recover TET after suspension of ADT within 6 months. This percentage reduces (not defined) with each Cycle of IAS.
Finally...in this article do a 'CTRL+F' (find) and you note that erectile tissue, erectile atrophy, nocturnal erections, venous leak and other specific aspects related to ADT use are not mentioned. I suppose that the authors think that the general term "ED Erectile Dysfunction," which is mentioned, covers these aspects...but there is so much involved in that term that Men do not know about, so much that will happen to them physically and permanently that is not explained, that using this throw away term, like is done in this article by the NIH, is malpractice...that is my opinion. If you need ADT take it! But know what will happen to you and dont walk into treatment only to find out later what "ED Erectile Dysfunction" really means...check this out. Rick
healthunlocked.com/active-s...
If 'T levels over 32 ng/dl are more prone to advance disease', then what is the point of being on intermittent?
'Castrate Level' used to be measured at <50 ng/dl but better disease control is now proven at <20. When I was on ADT it was <10. Any difference a man feels on a drug holiday at 30-50ng/dl is psychological.
Which is fine, unless the cost of placebo effect is the disease progressing at a distinctly faster rate.
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