I see a lot of men here taking ADT vacations…..wondering if( aside from amelioration of side effects for a while) if there is any other advantage to it? Appears to me to just be an invitation for semiresistent cells to gain a foothold……wrong?
any good reason to take an ADT vacati... - Advanced Prostate...
any good reason to take an ADT vacation….?
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Tommyj2
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Studies found no significant difference in overall survival between intermittent ADT and continuous ADT. But you get some relief from the ADT side effects.
You only get relief from the side effects if your testosterone recovers to at least low normal. The problem is you can’t know if it will, and even when it does it often takes a long time- longer than for the disease to take advantage.
I wrote "some". I agree that the QOL advantage is not that great. The first holiday has the longest duration and thus can be worthwhile.
Yes. However-sure, ‘some’ people get some relief, but you wrote ‘some relief’, implying all people get some.
Some get no relief at all of course. The availability and affordability of Orgovyx can only get better which should make for some better vacations. The T recovery from injectable ADT can be relatively interminable.
I don’t disagree with you that vacations are worth pursuing, One can’t know what it’s like unless you’ve been there. The vast majority of the doctors and other professionals who advise 100% against vacations have only knowledge of the side effects-not experience with them.
Let us also not forget time honored placebo effect, which is real as the day is long. If men feel much better when their T reaches say, 60ng/dl then who’s to argue?
The landmark trial found that there was about a 10% increase in survival with continuous ADT. There is no value to a vacation if testosterone does not recover.
Maha Hussain et al. reported the results of the SWOG-S9346 RCT. They randomized 1,535 men who were sensitive to hormone therapy.
After a median follow-up of 10 years:
• Overall survival was 5.8 years for cADT vs. 5.1 years for iADT
• Mortality increased 10% due to iADT (range 23% increase to a 1% decrease with 90% confidence).
• Because the median increase did not reach the prespecified 20% hazard ratio for a clinically important difference, but the confidence interval included it, and a small percent (1%) lived longer with iADT, the study was considered statistically inconclusive. In other words, iADT may have been inferior, although they couldn't prove it definitively with the statistics obtained.
•The iADT cohort had better erectile function and better mental health at 3 months but not thereafter.
• There was no difference in adverse events.
• Castration-resistance started after the same amount of time in each group, after adjustment for allowing the iADT group to prove rising PSA while receiving treatment (Figure S5).
nejm.org/doi/full/10.1056/N...
A secondary analysis of SWOG-S9346 trial combined with Medicare codes focused on the long-term side effects of iADT vs cADT. After 10 years:
• Thrombotic and ischemic events (e.g., heart, lung, or brain blockages and strokes) were significantly worse for iADT (33%) than for cADT (24%)
• There were no significant differences in bone, endocrine, or cognitive events.
jamanetwork.com/journals/ja...
Interesting.
'There is no value to a vacation if testosterone does not recover.'. Is that the key point right there?
It’s THE point.
Nice Bio. Interesting journey.
'Modern' medicine often appears surprisingly backward. Clouded with science.
since ADT’s goal is to push your T to a close to zero as possible, what’s the difference if your T stays down after pausing/stopping, after a long period on ADT ?
No difference, but no vacation.
Thanks; so this scenario is by definition not a vacation case.
He is using adjuvant ADT - no vacations.
I’ll take the extra 8 months. I have a second opinion and it didn’t include a vacation. For me with low to no PSA expression I could be toast at PSA 0.2 (the arbitrary trigger point) an extremely aggressive cancer with uncontrollable cancers every where. Why start a fire from a clean scan? They have been pressing me for months to the point of heavy handiness in a meeting yesterday to do this. My wife and I and my PCP agrees “don’t, your cancers are responding to treatment”. I intend to ride that horse until it dies. Yes vacations are appropriate for some where there’s lots of data or if they not tolerating the hormone treatment. To me taking a vacation would be the same as giving up and inconsistent with my belief that I will ultimately be cured many years from now.
While TA correctly cites the Hussain trial, there are some very key points not mentioned. First, this study was published in 2013 (12 years ago). The patients involved were not doing the triplet or doublet therapies commonly used today. . In fact, they were not even using advanced drugs like Zytega etc. . They did not have the far superior PSMA scans used today to better determine when to end a vacation. They also did not have the newer technology commonly used for SBRT to obliterate individual mets found on those PSMA scans. I am 30 months into my second vacation with a clean PSMA scan 60 days ago. I do one every 6 months. My first vacation ended after about 20 months when one met was found on L-5. I can say with certainty that my QOL is far superior while on vacation. Keep in mind both vacations did not begin until my PSA hit undetectable (.02-.03) for a couple of months. All I’m saying is the Hussain trial is pretty outdated given today’s treatments which could mean IADT is far better or far worse than that trial implied.
Schwah
Adding to what Schwah has already pointed out as problems with Hussain's SWOG-9346 study, a MAJOR design flaw was the PSA level to qualify for a vacation: 4 ng/dl or less. A PSA around 4 after continuous use of ADT shows that a patient is showing some signs that their PCa is castrate-resistant at some level. PSA levels of 4 have even sometimes shown golf ball-sized tumors in the prostate on diagnostic scans.Further, another major flaw was that the level of PSA that needed to be reached to go back on treatment was relatively high, giving the PCa a chance to flourish and gain a solid foothold. This would have been better limited had the treatment started back at a lower cutoff.
Under these circumstances, using these parameters in the clinical trial was irresponsible, and prejudiced the data towards continuous ADT.
Despite this glaring irresponsibility in study design, which didn't use doublet or triplet therapy that we now see as SOC, many oncologists still use SWOG-9346 as the final word on cADT vs. iADT today. Thankfully A-DREAM and the DE-ESCALATE trials are underway with better-designed parameters that will back up the anecdotal evidence of iADT success that we see from some mHSPC patients here.
You think you misunderstood the study.
In the iADT cohort, vacation was ended when PSA hit 20 ng/ml (or baseline if lower, or 10 ng/ml at doctor's discretion), and was triggered when PSA fell to 4 ng/ml or lower (65% were <0.2 at baseline). They were taken off the study if PSA didn't fall to 4 ng/ml while on ADT (indicating castration resistance), or if PSA rose again before the first 3 months of starting a vacation.
It's still the best info we have, and it alerts us to the danger and uselessness of iADT sometimes. But all this is besides the point, because the OP is having adjuvant ADT.
The quality of life I suppose is the biggest ’bonus’ of pausing ADT and then to hopefully minimize risks of having other types of diseases when being on ADT continous.
With undetectable PSA after for example the SBRT you had in addition to your ADT, wouldn’t you be curious to actually see what happens if you come of your ADT?
Best wishes - Ulf
I intend to find out after ive completed the recommended year of ADT “clean up” post radiation to sweep up resistent stragglers……the intention of this tx was to be curative……we’ll see
Yes, even though with 1 bone met and 1 lymph node positive, I wanted to go with with curative intent, even though conventional wisdom says a cure is not likely. That's why I went aggressive with Triplet therapy followed by IMRT. I'm in the category of "exceptional responder" as my PSA dropped below 0.1 by my 2nd docetaxel infusion and has been there ever since. I Stayed on hormone therapy for 24 months and with no evidence of disease, I elected to take a vacation from treatment. I may not make the same decision again if I have recurrence, but I did not want to stay on HT if I actually had a chance for cure. I would never know unless I took the vacation. I'm 14 months off treatment with no change and nothing on scans. I hope it holds!
Other reasons:
1) On the thin side, I was worried about the trajectory of my bone density and trying to avoid drugs for that.
2) A good chance for reasonably quick testosterone recovery due to my age.
I think it's a must do to avoid CRPC. Intermittent therapy is the key to prevent resistance.
I was on IHT for 26 years and the breaks I took made life worth living. I have now been on abirterone for 7 months w lupron and the side effects and decease in quality of life in my view will have me take a break soon. Hopefully my testosterone recovers and helps me rebuild my muscles etc.
more to follow boys as we have to push the boundaries!
billyboy3, you might consider using an antagonist (degalarix/Firmagon or relugolix/Orgovyx) instead of an agonist (Lupron). Antagonists do not have the testosterone surge agonists have and testosterone recovery when taking a break is considerably quicker, too. Adverse side effects are reported to be slightly better as well.
As for me, I am having great success with parenteral estradiol. My PSA is under 0.02 consistently since October 7, 2024 through Jan 13, 2025. Since stopping the Orgovyx on August 11 (PSA was 0.048 Aug 12 2024) and continuing with estradiol since then my testosterones have been under 20 ng/dL and PSA under 0.020. Orgovyx's side effects (other than loss of libido and muscle weakness), were mild but now completely gone and other organ functions unaffected (by assiduous, monthly monitoring of CMP and CBC).
no evidence for affecting resistance . One study NEJM showed small difference in outcome between continuous and intermittent therapy.
The PATCH study has shown E2 patches as a good as standard ADT but with a lot of benefits in terms of QOL, bones, metabolic side effects etc. Only downside is breast enlargement
Were participants treated with gynocomastia prevention like tamoxifen or Prophylactic RT?
But I guess tamoxifen could interfere with treatment...
No. From what I gather it was not a big problem and breast enlargement is not that uncommon in older men. I would opt for mastectomy if it bothered me. Look up the paper.
I plan to start it in place of adt in a month or two when I have restart treatment.
I was diagnosed in 2020 with Stage 4 ductal adenocarcinoma. I was prescribed a two year duration of ADT with EBRT after two months of ADT. My oncologist said that my treatment was over after the completion of the two year period of ADT treatment. She did not describe the end of my treatment as a “vacation “. She wanted to let the cancer “declare” itself after treatment.
After this two year treatment period my PSA and T were undetectable. Now, just over 2 years following termination of treatment, my PSA is 0.2 and my T is 12. My testosterone is still very low, however there is still no sign of the potential return of libido or erectile function.
I’m pleased that i no longer have any of the side effects of ADT, and i am fortunate that i have no radiation side effects so far either. Four years ago it felt like i had been given a death sentence. Today i just thank god for giving me access to such a good, caring, Oncologist and a very wise Urologist.
When my Oncologist said my treatment was over and now we wait and see, i protested a bit, mainly out of fear, but eventually agreed. I’m glad that I followed my Oncologists advice because she was 100% right. Always listen to your Oncologist.
I finished my treatment rt/ht in 2016 my psa is 0.04 but my testosterone has never recovered and now I have osteoporosis and it looks now that I also have proteinuria, I have had a good run so just have to get on with my new problems now.
I apologize. I should have read your profile before replying. Because you were posting on the advanced PCa forum, I had assumed you had advanced PCa and were mHSPC. Please ignore my previous reply.
You don't get a vacation. Vacations are for men on permanent ADT. You are just taking adjuvant ADT to help with your salvage radiation. There are no breaks. It would be like taking a break on antibiotics before you finish the cycle.
If you post on the following forum, it will prevent such misunderstandings in the future:
healthunlocked.com/prostate...
Thank you Allen….my apologies for the confusion…..
ive look into this too of course. I am metastatic as most on this forum are. Something to consider also would be the mental strain going BACK on ADT. Can you imagine taking a vacation and everything returns to normal but then you MUST go back on ADT......ugg, i think that would break me.
as one that has practiced ADT vacations for the last 4 years, for me it is worth it. My T has come back each time and that alone is worth it….but in addition, my hemoglobin also recovers albeit at a slower pace. Dropping RBC is also a side effect of orgovyx usage. The danger of a vacation is not stopping it at the right time. For the first 3 years I was doing them my MO advocated stopping when my PSA reached 2….this was good until he had me continue when I reached 1.9 for another month then it doubled that month. Because of that I now go off whenever it goes over 1. Hoping to start another next month. Good luck!
On vacation for last yr, after almost 2 yrs Eligard/Zytiga/Pred plus early Docetaxel. In "A-Dream" clinical trial, being studied. PSA stayed at 0.01 for 1 yr, now (just this week) measured at 0.13 but my "T" also went from <3 to 35. Onco says all normal for now. Scans all good. I asked about when we would resume ADT. When my PSA reaches 0.5 or so, then CT/bone scan and collate all results, then make decision. While my T has never meaningfully recovered while on vacation (not surprising...I'm almost 72 yrs old), I appreciate my organs/blood counts/etc etc, are getting a break. If the difference will be a few less months of life vs continuous ADT, I'm all for this!
I have been on Zytiga Prednisone Eligard since 2018 no vacation side effects are forever so doc says if ain't broke don't fix it.Never give up never surrender Leo
The purpose of ADT(Orgovyx, in my case) is to reduce the testosterone which feeds the cancer cells. If I stop ADT and testosterone does not recover or PSA stays low, why should I be taking ADT at all. Can't I enjoy the drug holiday until PSA reaches some level then do PSMA scan to determine cause and treat.
that is exactly what I am doing.. successfully cycled it three times so far after the miserable full year on to start (and I have NOT had radiation; no surgery and no chemo).. I'm 80 and unwilling to make myself miserable if the treatment is worse than the disease..
"...castration could be the key to extending the male lifespan...
interestingengineering.com/...
Ball Chick is a nut job.
With my PSA undetectable for 18 months, I took my last shot of Zoladex (similar to Lupron) at the end of August, and stopped Nubeqa cold turkey on January 1st.
Within days of dropping Nubeqa the stiffness and soreness in my joints was gone, and I was sleeping much better. Bloods from last week though show that my testosterone is still near zero, so it's not due to recovery.
Placebo? Maybe, but it could be too that Nubeqa was causing these issues that I attributed to low test and estrogen, and wasn't as side-effect free as the hype claimed.
I was on Lupron for 18 months following Radical Prostatectomy and salvage radiation, ending in July 2023. I had a year's vacation before my testosterone and PSA started to rise again. I was starting to feel excellent by the end of vacation. After vacation, had a lymph node radiated and started Orgovyx. I am 3 months into a 6 month Orgovyx treatment. It will be interesting to see where I am in mid-April when the 6 months is up. So far, my PSA has not dropped as much as I had hoped for. PSA went from 2.54 in September to 0.66 in October to 0.39 now. It is an interesting journey for us all...
Good luck to all!
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