We will know if intermittent maximum blockade is needed or not...
"The primary goal of this academic-led, open-label, multicenter, pragmatic, randomized phase III study is to investigate whether intermittent maximum androgen blockade (iMAB) can be safely administered to mHNPC patients who reached a PSA ≤ 0.2 ng/mL at 6-12 months of continuous treatment (cMAB), as compared to continuing cMAB. "
I'm going to read this now Max. Okay now I have read it - it's a new study starting in June but apparently has not started recruiting yet for 1600 people. It is being run out of Europe. It is scheduled to run all the way to 2029.
And as you say the idea is if you do maximum androgen blockade intermittently that you may delay resistance and patients will likely benefit from better quality of life in multiple dimensions including fatigue, cardiovascular risk, skeletal risk etc. Okay intimate relations too.
There are lots of papers written on this; I do like the emphasis on the question of maximum androgen blockade (MAB). In the "metastatic prostate cancer community" of course we all dread progression and the development of resistance. But it's almost just an accepted inevitability.
So the study's approach represents one of two frontiers (by my count) looking to turn metastatic prostate cancer into a chronic condition that one can live with more or less for many years.
Most of the research and support attention on the question of metastatic prostate cancer seems to be on getting better at killing the cancer.I call that approach number one.
But the big idea on this study and all the research that leads to this proposed study is "viable long-term suppression of PCa". This is a different approach and I believe very attractive. And possibly a good scientific hypothesis.
It's a little bit like what many of us do on our own, such as doing as much while planned exercises possible, or taking some well chosen supplement such as metformin or berberine etc.
A hypothesis of course is not a fact. The two arms of the study are (1) intermittent reduction of MAB and (2) no change in a MAB protocol.
So there are risks. We don't know if option one is viable. It seems to me that lots of posts on Health Unlocked asking about holidays, usually in an uninformed sort of way, are actually unknowingly proposing ARM number one above.
From my perspective having started on triplet therapy and experiencing success so far, I would love our number one above to be true. But I'm very nervous about trying it.
Super thanks for highlighting this Max!
No prob, by the way, I have created a workout program for one of the guys here (he is a weight training beginner). It's split in two parts, some conditioning and then the program itself. Wanna take a look?
Sure that would be really cool Max. I'd be grateful to see your program on exercise! It would be an encouragement!
By the way I will share with you one of my challenges around exercise (to separate from the fact that I started back at halftime work a couple of months ago and stop doing my exercise program!) is skeletal risk. Which restricts the kind of resistance exercise that I can do - and which I liked to do previously.
In my case I have three seriously compromised vertebrae (30 and 40% lucency). And it's impossible to get any serious guidance on this other than "don't twist". Has zero impact on my day-to-day life except I'm careful not to lift really heavy things and especially heavy things at an angle etc.
If you think about it have 40% loose and see might translate into a much larger loss of engineering strength. And a fracture would likely occur without warning. One thing I've been told is no more deadlifts.
I've written elsewhere about a paper I read that referred in passing to biomechanical engineering analysis of skeletal compromise and risk due to cancerous lesions and invasions. The comment was that this service is basically non-existent. The medical profession and medical institutions pay attention to some things and not others regardless of relative importance.
As we know, beyond lymph nodes one of the first places that PCa goes is the bones. And the spine therefore is a common side of metastases; we see this in some of the posts here.
You could reach exhaustion and myokines anyway! Let me send you a private message with the link
Please. I'll watch for the DM. And - go myokines! And apparently exerkines too (apparently the second is a super set of the first?).
On this Memorial day, I honor and mourn all those who proudly served our country.
Good Luck, Good Health and Good Humor.
j-o-h-n
Triple Hormone Blockade
Immunotheraphy and Covid-19?
PCa Abbreviation List UPDATED 1/26/2023 
Flutamide, bicalutamide, nilutamide, apalutamide or enzalutamide?
