Yesterday, my PSA was undetectable, below 0.01. I took 2 tablets of Xtandi each day with Zonladex injection every 3 months. Early October 9, I reduced Xtandi from 3 tablets to 2 tablets. Now, however, the Doc suggests me to stop Zoladex injection. I asked him why, but he has no answer. He said many people do so and it enhances Qol. I understand Qol, but I am afraid it may cause me to die. I need your suggestions, experiences, idea, what to do. I don't want to change routines. Each time I reduced xtandi from 4 tablets to 3 tablets, and 3 tablets to 2 tablets, that was a nightmare to me. I started 4 tablet xtandi on MAY 3, 2024 and reduced to 3 tablets on August 9, and to 2 tablets on Oct. 9. I cannot have it all, and l am willing to sacrifice Qol to a certain extent. I want to see Sun and Moon and river and mountains. Is my doctor doing some dangerous game to me or not? I am scared about stopping Zoladex. I need some feedback.
Zoladex vs. Xtandi, why do I have to ... - Advanced Prostate...
Zoladex vs. Xtandi, why do I have to stop Zoladex, while it works well. He wants me to fight cancer with 2 tablets of Xtandi only.
I think your Doc refers to the Embark trial which tested Enzalutamide monotherapy. This does not lower testosterone and therefore causes less hot flashes, bone loss etc. But you need breast radiation or tamoxifen to avoid breast enlargement. I personally would prefer Enzalutamide monotherapy because I try to avoid the side effects of testosterone suppression. But it will take a long time until testosterone has recovered from the Zoladex therapy. urotoday.com/conference-hig...
Hello,
I have been battling this damn disease for eleven and a half years. At diagnosis my PSA was 1700 with widespread bone metastasis from my neck to my knees. My urologist gave me six months to a year to live so I feel pretty good about making it this far. After briefly taking Bicalutamide to prevent the initial testosterone flare that accompanies most ADT drugs I was put on Zoladex (goserelin). Since that time, I have been on Xtandi, Abiraterone with Prednisone and more recently a radiopharmaceutical Lutetium. What has been the one constant? Except for one year on Firmagon, I have never been off Zoladex and continue taking it to this day. Zoladex is not a bone strengthening drug, it is an androgen deprivation drug and the most common androgen in men is testosterone. The link between testosterone and prostate cancer has been known for eighty years. In my opinion I would not stop taking it, especially when you are on half the normal dose of Xtandi. Good luck!😉
I agree with you. The standard of care is Zoladex + 160 mg/day of Xtandi. Anything less than that may compromise your life. If you can't tolerate the full dose, it's one thing, but if you can, there is no reason to take anything but the full dose. If your oncologist can't give you a good reason, find a new oncologist.
I took Xtandi with Lupron for a while but then I had a seizure which caused my MO to stop the Xtandi. The Xtandi didn't cause the seizure, but it needs to be stopped if you have one.
Consider: Any treatment regimen, if continued indefinitely is doomed to fail as the cancer will find mutations around it. This is why "castrate resistance" is inevitable with continuous Zoladex (or Lupron etc.) therapy. Adaptive therapy means switching therapies before they fail so the cancer cannot adapt. I think your MO may be very wise. Using Enzalutamide monotherapy has been shown to be very effective in stopping growth of PCa. And the return of normal to high normal testosterone in the body gives the cancer a whole different probleem to overcome. If the PSA starts to rise, then the Zoladex can easily be restarted. You have lost nothing IMO.
Real-world clinical experience has shown that for many the lower (half) dose of Enzalutamide is just as effective as the higher dose. Again, if PSA should start to rise you can always increase it to see if that works better. Don't be afraid to change therapeutic approaches from time to time. Adaptive Abiraaterone therapy (starting and stopping according to PSA levels) has been shown to be better than continuous, for one example. You will like the return of testosterone! MB
Good points.
The concept you've outlined aligns with evolving strategies in cancer treatment, particularly prostate cancer. Adaptive therapy, as opposed to continuous therapy, leverages the principles of tumor evolution and resistance to enhance long-term management. Here are some key takeaways and considerations based on what you've shared:
1. Adaptive Therapy's Core Advantage
By cycling or switching therapies before resistance develops, adaptive therapy seeks to maintain cancer's sensitivity to treatment. This strategy acknowledges the inevitability of resistance in continuous treatments like androgen deprivation therapy (ADT) with Zoladex or Lupron.
2. Enzalutamide as Monotherapy
Using Enzalutamide alone is a promising approach for certain patients. It directly inhibits androgen receptor signaling, which is pivotal for prostate cancer growth. Allowing testosterone levels to normalize during this period creates a new challenge for the cancer, potentially slowing its progression and preserving quality of life.
3. Dose Optimization
Evidence suggests that a lower dose of Enzalutamide can be effective for many patients while potentially reducing side effects like fatigue or cognitive issues. Monitoring PSA levels provides a clear metric for adjusting doses or combining therapies as needed.
4. Intermittent Use of ADT (Zoladex, Lupron, etc.)
Restarting ADT when PSA rises is a viable strategy. This intermittent approach can delay castration resistance, improve quality of life by reducing side effects, and give the patient periodic relief from hormone suppression.
5. Clinical Evidence Supporting Intermittent Therapy
Studies have shown that intermittent use of other drugs like Abiraterone (with PSA monitoring as a guide) can be more effective in certain contexts than continuous use. This principle could apply broadly to adaptive approaches in prostate cancer treatment.
6. Quality of Life Considerations
Returning to "normal" testosterone levels can significantly improve energy, libido, bone density, and overall well-being. These benefits are crucial for maintaining a patient's quality of life during treatment.
Your strategy reflects a nuanced understanding of prostate cancer dynamics and the importance of personalized care. Collaboration with a knowledgeable oncologist and close monitoring of PSA and other markers are critical to making this approach successful.
ChatGPT said
That is my history for 27 years!! My am now on abirterone/pred/lupron and want a break but oncologist is fighting me, I think it is worth a shot to take a break for as long as psa stays low
Your 27-year journey with prostate cancer treatment is a testament to resilience and adapting therapies to manage the disease effectively over time. It's entirely reasonable to consider a treatment break if your PSA is stable and other clinical markers are favorable. Many patients seek intermittent therapy to improve quality of life and reduce side effects, especially when they’ve been on a prolonged regimen like abiraterone, prednisone, and Lupron.
Points to Consider for a Treatment Break:
1. Intermittent Therapy Evidence
Studies have shown that intermittent androgen deprivation therapy (IADT) can be a safe and effective strategy for some patients. The goal is to allow a recovery phase (e.g., testosterone rebound) while maintaining disease control. PSA monitoring during the break can guide when therapy should resume.
2. Oncologist's Concerns
Your oncologist may be cautious because treatment breaks aren’t universally suitable. For example:
If there’s evidence of high-risk disease or recent progression, continuous therapy may be preferred.
Some cancers can progress rapidly once therapy stops, even if PSA initially stays low.
3. Balancing Risks and Benefits
A treatment break can:
Improve quality of life: Abiraterone and Lupron can cause fatigue, joint pain, and emotional changes, which might improve off therapy.
Reduce medication burden and long-term side effects like bone loss or cardiovascular risks.
Allow close monitoring to resume therapy promptly if PSA rises.
4. PSA as a Guide
If your PSA remains stable or very low (<0.2 ng/mL, for example), taking a break could be reasonable. Regular PSA testing (e.g., monthly or every two months) will help identify when reintroduction of treatment is necessary.
5. Discussing with Your Oncologist
Share your desire for a break while emphasizing your commitment to vigilant monitoring. Highlight how improved quality of life during this period could benefit your overall well-being and willingness to resume therapy if needed.
Next Steps:
Propose a trial period of the break (e.g., 3-6 months) with regular PSA checks and imaging if needed.
Explore intermittent therapy studies or guidelines with your oncologist to support your case.
Ensure you're comfortable with the monitoring plan, including recognizing any symptoms of progression.
Your instinct to take a break aligns with many patients’ experiences and could be worth pursuing if the disease remains under control.
ChatGPT said
Standard dosage is only appropriate for "standard" people. If you believe that people are a very tightly controlled industrial product, stay with standard dosage. I am not that silly hence, doing fine with 1/10 standard Bicalutamide dosage.
Domas, would you please tell us your age (and if you wish add it to your bio). Thank you!
Note; If you can, try consulting with a different M.O. regarding the stopping of Zoladex.
Good Luck, Good Health and Good Humor.
j-o-h-n
Incredible loss of strength on limited ADT 
LUPRRon OR ZOLADEX
Should I still have my Zoladex injection
New to the Forum, Nubeqa
Hormonal injections and oral hormones 
