My father , Gleason 9 dx a year ago, had local spread but had Prostate removed - dx psa 14… - 2 lymphnodes still lit up post removal - psa never below 8 post surgery,… on ADT right away - at 3 month psa was undetectable- spot beam proton radiation 3 months ago - a month post radiation - psa still undetectable (less than .02)
He hates the hormones - his doctor told him he could go off - so he did. I’m so confused as to how they’re allowing this to happen? In my research it seems he should be on it longer and most folks are on it their whole lives. Now saying come back in 3 months for psa check. This doesn’t seem right.
Please advise, I want him to get second opinion and want to see if anyone else can please provide any advice / suggestions / experience - at Dana farber. Thank you so much.
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His salvage radiation+ADT was potentially curative. However, the SOC is for 3 years of ADT and 2 years of Zytiga along with the radiation. Doctors want to accommodate patients and can't force a patient to stay on hormone therapy against his will.
If the PSA value is undetectable you can take a break with ADT. This is called intermittent ADT. Recently the Embark trial has demonstrated that this is a good alternative. pubmed.ncbi.nlm.nih.gov/343...
Nobody knows for sure whether it can be curative with just a few months of ADT or not, TallAllen is just pointing out that the studies they have done show much better success with 3 year. So it's just a gamble you take yourself, based on your own quality of life issues.
Surgery and radiation are therapies with curative intention. I think chances are small that they will be curative when there is a Gleason 9.
If your father prefers quality of life and decides to live without ADT for a while I think he can do that. He can start with ADT whenever he feels it is necessary.
That article says: "The main objective of EMBARK is the comparative assessment of enzalutamide plus leuprolide... or enzalutamide monotherapy... " I don't see mention of intermittent ADT.
This report mentions: "Treatment was suspended at week 37 if the PSA level was less than 0.2 ng per milliliter and was restarted when the PSA level was at least 5.0 ng per milliliter (if the patient had not had previous radical prostatectomy) or at least 2.0 ng per milliliter (if the patient had previously had radical prostatectomy)." nejm.org/doi/full/10.1056/N...
I see that deep in the middle of the article, but it is not called out as intermittent ADT and not connected to the outcome of the trial in its results and conclusions paragraphs. There are many links specifically about intermittent ADT. ncbi.nlm.nih.gov/pmc/articl...auajournals.org/doi/10.1097...
"If the PSA value is undetectable you can take a break with ADT. This is called intermittent ADT. "
I can't figure out whether iADT is good or not. In a reply to jackwfrench, T_A once posted this observation against stopping ADT just because the PSA stays low:
The trials testing intermittent ADT could not demonstrate that intermittent ADT results in a significantly shorter overall survival than continuous ADT. But most oncologists are convinced that continuous ADT is better. If the patient has no problems with the side effects of ADT he can get continuous ADT. If he wants to improve his QOL he can choose intermittent ADT. The Embark trial showed that this can result in a long holiday.
For me, the suspense of waiting for the cancer to grow more during the ADT "holiday" was more stressful than the side effects of ADT.
When my case (G9, 5+4, stage 3 at dx) was recurring, I decided on permanent ADT. I also take estradiol to offset the side effects. Lack of libido, ED, and some gynecomastia are part of this approach, and not everyone can live with those.
It's tough. We all have to choose the balance between therapy and quality of life, a very personal choice.
I absolutely do not wish to cause offence, but it sounds like your dad is making his own choice. You ask how "they are allowing this to happen" as though someone should prevent him? It is the opposite, your dad is a free agent who is making his own choices. Perhaps you should talk more to your dad about why he has made this choice. By all means ensure he is fully informed about the pros and cons, but after that it is his decision.
Hello all - Politely speaking, I will keep cutting the grass ( cancer) rather than stopping , as I dont want to come back to a field of shoulder high grass - However I cannot agree more with the statement that we all have to make our own decisions in our own treatment regimes - good luck everyone in the fight - please somebody find a cure for all cancers - A.I perhaps will make the breakthrough we desperately need - kindest Raoul
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