Slight PSA rise and MO discontinuing ADT due to fatigue

[Superbfloor]

Father, 86, Stage 4A prostate cancer has been treated under STAMPEDE Protocol since November 2022 including prostate + whole pelvic radiation completed March 2023 (history in bio).

Had appointment with MO today - initial plan was for this to be last shot of Lupron while Zytiga would be continued for 3 more months. PSA had been stable at 0.10 since October 2023 but was measured at 0.14 today. MO recommended cancelling today's Lupron shot and weaning off the Zytiga / prednisone as he has lost muscle mass on ADT and had some balance issues including a fall a few months back. MO says have gotten significant benefits off what has been done already and risks of continuing ADT outweigh benefits. He still tries to remain active in the yard and with light exercise but has significant knee pain now which bothers him when walking for more than 10 minutes or so. He is also anemic due to ADT with RBC around 3.5 and Hemoglobin of 11.5.

Plan would be to check PSA again in 3 months and go from there. I believe another PSMA scan would not be performed until the PSA is >2. I would have been more comfortable with this if PSA had gotten to undetectable levels but worry since it has now bounced from the nadir. I certainly want him to increase his QOL but also to avoid the need for harsher treatments down the line to the extent possible. Does stopping ADT / an ADT 'vacation' seem reasonable at this point?

[j-o-h-n]

Greetings Superbfloor,

Hopefully he's not rating the condition of the floor by lying down on it. You see I'm 87 and suffer from many of the issues that your dear Dad has. Especially losing my balance and I don't want to end up lying on the floor. I've been on Lupron for ages but recently was taken off Casodex which was replaced by Nubeqa (which lowered my PSA). Maybe ask his doc if he can use Nubeqa to fight the beast. You're a great sibling and keep up the good work.

p.s. Update his bio, helps him and helps us too (all info voluntary).

Good Luck, Good Health and Good Humor.

j-o-h-n

[Roxysdad]

I’m no doctor, but check out BAT (testosterone) If his doc will go for it his QOL will go up significantly….But no doubt his PSA will go up also… So it’s a trade off…QOL or staying as is IMO and buying more time..,

[janebob99]

You may want to Google "Intermittent ADT", and you will find many papers that support the intermittent stopping of ADT as a "vacation", followed by restarting the ADT after a period of time. Results generally support this method of treatment.

[Mike1971]

Superbfloor, I don’t know what the best course of action from a medical standpoint would be, but will share a perhaps different view from some. I was DXed with a little more spread and had a fairly similar treatment, but cut my ADT treatment short at two years. By then I had transformed from a fit and “healthy” 49 y/o person into just skin and bones, anemic and deeply depressed. I have always been a very positive glass always half full kind of a guy, having lots of love and enjoying life immensely, but after two and a half years of treatments and ADT I was just a shadow of the former me. I had a few disastrous events happening to me during treatment which tipped me over, but the ADT and the castration was just too harsh for my body and mind to continue.

So, I stopped ADT early. A decision my doctor actually suggested due to my deteriorating health. And I was fully aware of the dangers doing so.

This gave me 10 months of my normal life back. A time invaluable to me.

This also meant my cancer is now back, at 53 y/o.

Did I do the right thing? For most people, maybe not. For me - I really had no choice. Continuing ADT would probably mean my cancer would still be in check, but at a price I simply couldn’t pay. And continuing just to stay alive for my wife’s sake wasn’t really an option either, as the walking dead person I had turned into was no person to share a life with anyway.

I’m sorry I don’t have any suggestion or can offer any help. QoL is a big factor to consider. So is staying alive. What should one do? It is really, really, really hard to say.

I hope your dad gets to enjoy many more years without reoccurrence.